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

Emotional distress and dysregulation as treatment targets to reduce suicide in psychosis: a scoping review

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.

Alteration in left frontoparietal connectivity correlates with impaired cognitive reappraisal in early psychosis

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.

Emotion regulation flexibility and psychosis: A longitudinal study disentangling components of flexibility in psychosis-proneness

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.

Impaired emotional awareness is associated with childhood maltreatment exposure and positive symptoms in schizophrenia

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.

Intrinsic neural network dynamics underlying the ability to down-regulate emotions in male perpetrators of intimate partner violence against women

Research has pointed to difficulties in emotion regulation as a risk factor for perpetrating intimate partner violence against women (IPVAW). While efforts have been made to understand the brain mechanisms underlying emotion regulation strategies such as reappraisal, little is known about the intrinsic neural dynamics supporting this strategy in male perpetrators. Resting-state functional magnetic resonance imaging was used to characterise the network dynamics underlying reappraisal. Spectral dynamic causal modelling was performed to examine the effective connectivity (EC) within a predefined reappraisal-related brain network. 26 men convicted for an IPVAW crime [male perpetrators] were compared to 29 men convicted of other crimes [other offenders] and 29 men with no criminal records [non-offenders]. The ability to down-regulate emotions in response to IPVAW stimuli was used as a covariate to explore its association with male perpetrators' EC. The analysis revealed that (1) compared to non-offenders, both convicted groups exhibited increased EC within prefrontal areas, enhanced EC from prefrontal to temporoparietal regions and decreased EC in the opposite direction; (2) male perpetrators compared to other offenders showed increased EC from temporoparietal to prefrontal regions and, increased EC from the supplementary motor area to frontal areas; (3) connections involving dorsolateral prefrontal cortex were found to be potential predictors of the ability to down-regulate emotions. The study provides a deeper characterisation of the brain architecture of the processes that underlie IPVAW. This knowledge could inform the work of adaptive emotion regulation strategies in intervention programmes for male perpetrators in order to reduce the high recidivism rates.

Deconstructing emotion regulation in schizophrenia: The nature of abnormalities at the selection and implementation stages

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).

Components of emotion regulation flexibility and psychosis: The association between psychosis-proneness and context sensitivity

OBJECTIVES

Emotion regulation flexibility has been conceptualized as a multi-componential construct involving context sensitivity, repertoire and feedback responsiveness. Psychosis research has yet to incorporate these new developments in the study of emotion regulation. Thus, we sought to advance even further the knowledge on emotion regulation in psychosis by adopting the emotion regulation flexibility approach as proposed by Bonanno and Burton (Perspectives on Psychological Science, 2013, 8, 591).

METHOD

In total, 401 participants completed 4 scales assessing the multi-components of emotion regulation flexibility and psychosis-proneness.

RESULTS

Our results indicated that Context Sensitivity (i.e., Cue Absence) and Feedback Responsiveness (i.e., Evaluation) were associated with psychosis-proneness. Cue absence was specifically associated with the positive dimension, while both Cue Absence and Enhancement ability were associated with the negative dimension.

CONCLUSIONS

Overall, our results suggest that emotional context insensitivity is the most relevant component of regulatory flexibility in the case of psychosis-proneness. Thus, the disruption in this first step of flexible emotion regulation might be already present in those prone to psychosis. Difficulties in decoding appropriately the contextual cues might further disrupt the other steps of emotion regulation contributing to the psychotic (-like) experiences. This study needs replication in clinical and non-clinical samples.

Beliefs About the Uncontrollability and Usefulness of Emotion in the Schizophrenia-Spectrum: Links to Emotion Regulation and Negative Symptoms

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.

Dysconnectivity between the anterior insula and the dorsal anterior cingulate cortex during an emotion go/nogo paradigm is associated with aggressive behaviors in male schizophrenia patients

This study aimed to investigate the association between past-reported violent/aggressive behaviors and brain functional connectivity in male patients suffering from schizophrenia using a task modeling the interaction between negative emotion processing and response inhibition. Forty-four male patients with schizophrenia and twenty-two healthy male controls performed an emotional go/no-go task using angry and neutral faces during a functional magnetic resonance imaging session. Generalized psycho-physiological interaction was conducted to explore task-based functional connectivity and a negative binomial regression was used to evaluate the relationship between neural alterations and violent/aggressive behaviors. Regions involved in response inhibition and emotion regulation, such as the anterior insula, dorsal anterior cingulate cortex (dACC) and dorsolateral prefrontal cortex (DLPFC), were used as seed regions. During emotion-related response inhibition, patients with schizophrenia displayed altered connectivity between the anterior insula and amygdala, the DLPFC and lateral orbitofrontal cortex (OFC), as well as the anterior insula and the dACC when compared to healthy individuals. The latter was negatively associated with aggressive behaviors in participants with schizophrenia (Wald χ² = 9.51; p < 0.05, p-FDR corrected). Our results highlight alterations in functional connectivity in brain regions involved in cognitive control and emotion processing which are associated with aggressive behaviors in schizophrenia.

Facing the pandemic and lockdown: an insight on mental health from a longitudinal study using diaries

We conducted a longitudinal online study to examine attenuated psychotic symptoms (APS) over time in a sample of locked-down individuals. We used (i) questionnaires and (ii) the automatic analysis of the emotional content of narratives. Participants (N = 162) were recruited to complete an online survey 4 times between March and June 2020 (T1, T2, T3, T4). T1 completion coincided with the beginning of the lockdown, and T4 with the pandemic trough. Depression, anxiety, and stress were assessed with the DASS-42 and APS with the PQ-16. Psychosocial data such as the feeling of loneliness and social network size were also collected. The participants wrote daily narratives during the lockdown period. Anxiety and APS were the highest at T1 and decreased over time. APS and APS-associated distress were correlated with the DASS-42 at all times. APS arose acutely at the beginning of the pandemic, despite participants being socio-economically advantaged, and were related with negative emotions.

Deconstructing emotion regulation in schizophrenia: the nature and consequences of abnormalities at the identification stage

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.

Description of a Dialectical Behavior Therapy program in a Veterans Affairs Health Care System

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.

Deconstructing emotion regulation in schizophrenia: The nature and consequences of abnormalities in monitoring dynamics

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.

Dispositional Mindfulness and Psychotic Symptoms in Schizophrenia Spectrum Disorders: The Mediating Roles of Rumination and Negative Emotion

INTRODUCTION

Studies have shown that rumination plays a significant mediating role between dispositional mindfulness (DM) and psychopathological symptoms in both clinical and non-clinical populations. However, no studies have examined this pathway in people with schizophrenia spectrum disorders (SSDs).

METHODS

A cross-sectional, clinician-administered survey was conducted among people with SSDs (n = 52) in a community setting. Participants completed the Chinese versions of the Depression Anxiety Stress Scale, Five Facet Mindfulness Questionnaire-Short Form, Psychotic Symptom Rating Scale and Scale for the Assessment of Negative Symptoms. Structural equation modelling was performed to examine the pathways of mindfulness facets, rumination, negative emotions and psychotic symptoms.

RESULTS

Two facets of mindfulness (nonjudging and acting with awareness) reduced rumination and negative emotional status. Rumination fully mediated the relationship between nonjudging and negative emotions and partially mediated the relationship between acting with awareness and negative emotions. Furthermore, rumination and negative emotions sequentially mediated the relationship between acting with awareness and hallucination (B = -0.44, 95% confidence interval [CI] = -0.338 to -0.045, p = 0.01) and between nonjudging and hallucination (B = -0.356, 95% CI = -0.255 to -0.008, p = 0.034). The model fit the data well (χ²(2) = 1.318, p = 0.517, Tucker-Lewis index = 1.075, comparative fit index = 1, standardised root mean residual = 0.0251, root mean square error of approximation = 0.0001).

CONCLUSION

Rumination and negative emotions serially mediated the relationship between DM and hallucination. The findings support the contribution of changes across transdiagnostic mediators underlying the therapeutic effects of mindfulness training. Further research examining the transdiagnostic processes of DM in influencing clinical outcomes in SSDs is warranted.

Manipulating feedback on schizophrenia: Evidence from a Posner task

Individuals with schizophrenia show difficulties in achieving vital objectives. Abnormal behavioral and emotional responses to environmental feedback may be some of the psychological mechanisms underlying this lack of goal attainment in schizophrenia. The present study aims to assess how different types of feedback may affect performance in a computerized affective Posner task (non-monetary vs. monetary rewards; contingent vs. non-contingent feedback). The sample was composed of 32 patients with schizophrenia and 35 controls. Reaction times and error rates were the behavioral measurements. The emotional experience was assessed through self-reported affective scales. The results indicated that: ii) the performance with monetary rewards was better than with non-monetary ones in all participants, especially in patients with schizophrenia when higher attentional resources are required (invalid trials). Second, all participants demonstrated faster reaction times, but higher error rates, with non-contingent feedback (frustration condition). Significantly, the schizophrenia group only equaled the controls performance in the non-contingent condition with monetary rewards. Additionally, the higher the negative symptoms were in patients, the worse performance they had under frustration. Third, discrepancies between performance and self-report affect were found in patients. Specifically, after the induction of frustration, the patients reported feeling better and having no arousal changes. Therefore, the findings suggest that, in schizophrenia: i) non-monetary rewards are relatively less important; ii) monetary rewards lessen the negative effects of frustration, iii) discrepancies in self-reported affective scales suggest an unrealistic self-evaluation made under frustration. These findings shed light on the underlying mechanisms of the lack of goal attainment in schizophrenia.

Aberrant salience and reward processing: a comparison of measures in schizophrenia and anxiety

BACKGROUND

Aberrant salience may contribute to the development of schizophrenia symptoms via alterations in reward processing and motivation. However, tests of this hypothesis have yielded inconsistent results. These inconsistencies may reflect problems with the validity and specificity of measures of aberrant salience in schizophrenia. Therefore, we investigated relationships among measures of aberrant salience, reward, and motivation in schizophrenia and anxiety.

METHOD

Individuals with schizophrenia (n = 30), anxiety (n = 33) or unaffected by mental disorder (n = 30) completed measures of aberrant salience [Aberrant Salience Inventory (ASI), Salience Attribution Test (SAT)], motivation (Effort Expenditure for Reward Task), and reinforcer sensitivity (Stimulus Chase Task).

RESULTS

Schizophrenia participants scored higher than anxiety (d = 0.71) and unaffected (d = 1.54) groups on the ASI and exhibited greater aberrant salience (d = 0.60) and lower adaptive salience (d = 0.98) than anxious participants on the SAT. There was no evidence of a correlation between measures of aberrant salience. Schizophrenia was associated with related deficits in motivated behaviour and maladaptive reward processing. However, these differences in reward processing did not correlate with aberrant salience measures.

CONCLUSIONS

The results suggest that key measures of aberrant salience have limited specificity and validity. These problems may account for inconsistent findings reported in the literature.

Self-reported emotion regulation difficulties in psychosis: Psychometric properties of the Difficulties in Emotion Regulation Scale (DERS-16)

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.

Forgetting Unwanted Memories: Active Forgetting and Implications for the Development of Psychological Disorders

Intrusive memories are a common feature of many psychopathologies, and suppression-induced forgetting of unwanted memories appears as a critical ability to preserve mental health. In recent years, biological and cognitive studies converged in revealing that forgetting is due to active processes. Recent neurobiological studies provide evidence on the active role of main neurotransmitter systems in forgetting, suggesting that the brain actively works to suppress retrieval of unwanted memories. On the cognitive side, there is evidence that voluntary and involuntary processes (here termed "intentional" and "incidental" forgetting, respectively) contribute to active forgetting. In intentional forgetting, an inhibitory control mechanism suppresses awareness of unwanted memories at encoding or retrieval. In incidental forgetting, retrieval practice of some memories involuntarily suppresses the retrieval of other related memories. In this review we describe recent findings on deficits in active forgetting observed in psychopathologies, like post-traumatic stress disorder, depression, schizophrenia, and obsessive-compulsive disorder. Moreover, we report studies in which the role of neurotransmitter systems, known to be involved in the pathogenesis of mental disorders, has been investigated in active forgetting paradigms. The possibility that biological and cognitive mechanisms of active forgetting could be considered as hallmarks of the early onset of psychopathologies is also discussed.

An experimental study on the effectiveness of emotion regulation in patients with acute delusions

BACKGROUND

Patients with psychotic disorders report to apply more maladaptive and less adaptive emotion-regulation (ER) strategies compared to healthy controls. However, few studies have used experimental designs to investigate the success in ER and the results of those at hand are equivocal.

AIM

This study investigated whether patients with delusions show problems in downregulating negative affect via cognitive ER-strategies.

METHOD

Patients with schizophrenia spectrum disorders and acute delusions (n = 78) and healthy controls (n = 41) took part in an ER-experiment, in which they were instructed to downregulate anxiety and sadness via three ER-strategies (reappraisal, distraction, acceptance) or not to regulate their emotions (control-condition). ER-success was measured as the change in subjective emotion-intensity and physiological indicators (skin conductance and heart rate) from before to after regulation and was analyzed with mixed-repeated-measures ANOVAs.

RESULTS

We found a significant effect of the ER-strategy in the sense that the subjective emotion-intensity was significantly lower after applying the reappraisal- and distraction-strategies than after the just view-condition (p's < .001). This effect was not found for the acceptance strategy (p = .060). There was no ER-strategy ∗ time ∗ group interaction-effect F(4.918, 575.416) = 0.778, p = .564, ƞ²_partial = 0.007. In all conditions, skin conductance decreased from pre- to post regulation (p < .001).

CONCLUSION

Our results indicate that patients with acute delusions can successfully apply cognitive ER-strategies. Before pursuing the relevant clinical implications of this finding, further research is needed to explore the role that the type of instruction has on ER-success and the extent to which the findings can be generalized to real life settings.

Empathy and Its Relationship With Social Functioning in Individuals at Ultra-High Risk for Psychosis

Introduction: Social functioning is often impaired in the ultra-high-risk (UHR) phase of psychosis. There is some evidence that empathy is also impaired in this phase and that these impairments may underlie difficulties in social functioning. The main aim of this study was to investigate whether cognitive and affective empathy are lower in people in the UHR phase of psychosis in comparison to healthy controls, and whether possible impairments have the same magnitude as in people with schizophrenia. A second aim was to examine whether there is a relationship between empathy and social functioning in individuals in the UHR phase. Method: Forty-three individuals at UHR for psychosis, 92 people with a schizophrenia spectrum disorder, and 49 persons without a psychiatric disorder completed the Interpersonal Reactivity Index (IRI), Questionnaire of Cognitive and Affective Empathy (QCAE), and Faux Pas as instruments to measure empathy. The Time Use survey was used to measure social functioning. MAN(C)OVA was used to analyse differences between groups on empathy and social functioning, and correlations were calculated between empathy measures and social functioning for each group. Results: The UHR group presented significantly lower levels of self-reported cognitive empathy than the healthy controls, but not compared to patients with SSD, while performance-based cognitive empathy was unimpaired in the UHR group. On the affective measures, we found that people with UHR and patients with SSD had significantly higher levels of self-reported distress in interpersonal settings compared to healthy controls. In the UHR group, perspective-taking was negatively associated with time spent on structured social activities. In the SSD group, we found that structured social activities were positively associated with perspective-taking and negatively associated with personal distress in interactions with others. Lastly, in people without mental illness, social activities were positively associated with performance-based perspective-taking. Conclusion: Impairments in subjective cognitive empathy appear to be present in the UHR phase, suggesting that difficulties in interpreting the thoughts and feelings of others precede the onset of psychotic disorders. This can inform future interventions in the UHR phase.

Reward processing electrophysiology in schizophrenia: Effects of age and illness phase

BACKGROUND

Reward processing abnormalities may underlie characteristic pleasure and motivational impairments in schizophrenia. Some neural measures of reward processing show age-related modulation, highlighting the importance of considering age effects on reward sensitivity. We compared event-related potentials (ERPs) reflecting reward anticipation (stimulus-preceding negativity, SPN) and evaluation (reward positivity, RewP; late positive potential, LPP) across individuals with schizophrenia (SZ) and healthy controls (HC), with an emphasis on examining the effects of chronological age, brain age (i.e., predicted age based on neurobiological measures), and illness phase.

METHODS

Subjects underwent EEG while completing a slot-machine task for which rewards were not dependent on performance accuracy, speed, or response preparation. Slot-machine task EEG responses were compared between 54 SZ and 54 HC individuals, ages 19 to 65. Reward-related ERPs were analyzed with respect to chronological age, categorically-defined illness phase (early; ESZ versus chronic schizophrenia; CSZ), and were used to model brain age relative to chronological age.

RESULTS

Illness phase-focused analyses indicated there were no group differences in average SPN or RewP amplitudes. However, a group × reward outcome interaction revealed that ESZ differed from HC in later outcome processing, reflected by greater LPP responses following loss versus reward (a reversal of the HC pattern). While brain age estimates did not differ among groups, depressive symptoms in SZ were associated with older brain age estimates while controlling for negative symptoms.

CONCLUSIONS

ESZ and CSZ did not differ from HC in reward anticipation or early outcome processing during a cognitively undemanding reward task, highlighting areas of preserved functioning. However, ESZ showed altered later reward outcome evaluation, pointing to selective reward deficits during the early illness phase of schizophrenia. Further, an association between ERP-derived brain age and depressive symptoms in SZ extends prior findings linking depression with reward-related ERP blunting. Taken together, both illness phase and age may impact reward processing among SZ, and brain aging may offer a promising, novel marker of reward dysfunction that warrants further study.

Emotion-Regulation in Psychosis: Patients with Psychotic Disorders Apply Reappraisal Successfully

Background

Emotion-regulation is assumed to be impaired in psychosis: patients with psychotic disorders (PD) self-report to use reappraisal less frequently than healthy controls (HC), but it is uncertain whether they are also less successful in applying reappraisal. Moreover, it has not been investigated whether the habitual use of reappraisal is associated with the ability to use reappraisal successfully.

Methods

To address these questions, PD (n = 60), a clinical control group of patients with anxiety disorders (AD; n = 40) and HC (n = 40) completed questionnaires on habitual emotion-regulation and alexithymia, performed tests on neurocognitive functioning and jumping-to-conclusion bias, and were subjected to an emotion-regulation paradigm, in which they were asked to down-regulate induced anxiety and sadness.

Results

No differences were found between PD and HC regarding the habitual use of reappraisal, but PD reported to use reappraisal more frequently than AD. All groups were able to down-regulate anxiety and sadness via reappraisal following instructions. The habitual use of reappraisal and the reduction of anxiety and sadness after instruction were uncorrelated.

Conclusion

These findings question the common assumption that PD use reappraisal less often or less successfully. At least under laboratory condition, PD do not appear to be impaired in reducing negative affect via reappraisal successfully.

Emotion regulation across the psychosis continuum

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.

Neurophysiological Correlate of Emotion Regulation by Cognitive Reappraisal and Its Association With Psychotic Symptoms in Early Psychosis

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.

Neurophysiological evidence for emotion regulation impairment in schizophrenia: The role of visual attention and cognitive effort

Prior research indicates that individuals with schizophrenia (SZ) display emotion regulation abnormalities that are critically linked to increased symptom severity and poor functional outcome. However, processes contributing to the aberrant implementation of various strategies are unclear. The current study took a multimodal approach to identifying mechanisms underlying the impaired implementation of 2 strategies: reappraisal and distraction. Participants included 25 individuals with SZ and 25 healthy controls (CN) who completed separate event-related potential and eye-tracking/pupil dilation tasks. On each task, participants were required to either passively view unpleasant or neutral stimuli or reduce negative affect using reappraisal or distraction emotion regulation strategies. The late positive potential (LPP) event related potential component was used as an objective neurophysiological indicator of emotion regulation effectiveness. Eye tracking and pupil dilation were used to determine whether the implementation of reappraisal and distraction were associated with abnormal patterns of visual attention and reduced cognitive effort, respectively. Results indicated that CN could effectively decrease the amplitude of the LPP for both reappraisal and distraction compared with unpleasant passive viewing; however, individuals with SZ showed comparable LPP amplitude among conditions, indicating a failure to effectively implement these strategies. In CN, successful down-regulation of negative affect was associated with different patterns of visual attention across regulation strategies. During reappraisal, there was an increase in fixations to arousing scene regions, whereas distraction was associated with reduced attention to arousing interest areas. In contrast, individuals with SZ made fewer fixations to arousing interest areas during reappraisal and more fixations to arousing interest areas during distraction. Furthermore, pupil dilation results suggested that individuals with SZ failed to exert adequate effort while implementing reappraisal. Collectively, these findings suggest that individuals with SZ are ineffective at implementing reappraisal and distraction; dysfunctional patterns of visual attention and low cognitive effort may contribute to these difficulties. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Examining Specificity of Neural Correlates of Childhood Psychotic-like Experiences During an Emotional n-Back Task

BACKGROUND

Psychotic-like experiences (PLEs) during childhood are associated with greater risk of developing a psychotic disorder in adulthood, highlighting the importance of identifying neural correlates of childhood PLEs. Furthermore, impairment of cognitive functions, such as working memory and emotion regulation, has also been linked to psychosis risk as well as to disruptions in several brain regions. However, impairments in these domains have also been linked to other disorders, including depression. Therefore, the aim of the current study was to examine whether neural impairments in regions associated with working memory and implicit emotion regulation impairments are specific to PLEs versus depression.

METHODS

The current study used an emotional n-back task to examine the relationship between childhood PLEs and neural activation of regions involved in both working memory and implicit emotion regulation using data from 8805 9- to 11-year-olds in the Adolescent Brain Cognitive Development (ABCD) Study 2.0 release. To examine specificity, we also analyzed associations with depressive symptoms.

RESULTS

Our results indicated that increased PLEs during middle childhood were associated with decreased activation of the dorsolateral prefrontal cortex, striatum, and pallidum during trials requiring working memory. In contrast, increased activation of the parahippocampus, caudate, nucleus accumbens, and rostral anterior cingulate during face-viewing trials was associated with increased depressive symptoms.

CONCLUSIONS

These results support the dimensional view of psychosis across the lifespan, providing evidence that neural correlates of PLEs, such as decreased activation during working memory, are present during middle childhood. Furthermore, these correlates are specific to psychotic-like symptoms as compared with depressive symptoms.

Using questionnaires and task-related EEG signals to reveal hindered reappraisal and biased suppression in individuals with high schizotypal traits

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.

The impact of emotion awareness and regulation on psychotic symptoms during daily functioning

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.

Implicit emotion regulation deficits in individuals with high schizotypal traits: an ERP study

Schizotypy is associated with poor emotion regulation that is thought to contribute to the development of psychotic symptoms and to indicate a predisposition to schizophrenia. Having focused primarily on the relationship between schizotypy and explicit emotion regulation, existing studies have, until now, neglected to acknowledge the potentially important role of implicit emotion regulation. Our aim in the current study was to investigate implicit emotion regulation deficits in schizotypy. To this end, we used a newly developed Priming-Identification (PI) ERP paradigm, consisting of a priming phase and an emotion identification phase, to test 30 individuals with schizotypy and 30 healthy controls while also acquiring EEG data. During the priming phase, we aimed to manipulate emotion regulation goals (i.e., to bring about an intended emotional state) by presenting a category of words related to emotion regulation alongside a category of control words. Associated brain responses occurring during the subsequent stage were indexed according to three ERP components: N170, early posterior negativity (EPN) and late positive potential (LPP). Results showed that, in the control group, priming words associated with emotion regulation led to enhancements in the early N170 amplitude and the middle EPN during expression identification. The same pattern was not observed in the schizotypy group. In summary, our results suggest the presence of deficits in the early and middle stages of the implicit emotion regulation process among individuals with high schizotypal traits.

The Effectiveness of a Mindfulness-Based Psychoeducation Programme for Emotional Regulation in Individuals with Schizophrenia Spectrum Disorders: A Pilot Randomised Controlled Trial

BACKGROUND

Emotion dysregulation has emerged as a transdiagnostic factor that potentially exacerbates the risk of early-onset, maintenance, and relapse of psychosis. Mindfulness is described as the awareness that emerges from paying attention to the present moment without judgment. It gently pulls the mind out of the negative emotions induced by the disparity between expectation and reality by focusing on the present moment, instead of worrying about the future or regretting the past. However, only a few research has ever focused on the efficacy of using a mindfulness-based intervention to improve emotion regulation in schizophrenia spectrum disorders.

PURPOSE

The purpose of this study was to examine the effectiveness of a Mindfulness-Based Psychoeducation Programme (MBPP) on the emotion regulation of individuals with schizophrenia, in particular, to access emotion regulation strategies. The objective of this study was to find out whether MBPP is feasible for improving emotion regulation strategies, in terms of rumination, cognitive reappraisal, and expressive suppression, with a sustainable effect at a three-month follow-up.

PATIENTS AND METHODS

A single-blinded pilot randomised controlled trial with repeated-measures designs was adopted. Forty-six participants diagnosed with schizophrenia and its subtypes were randomised in either the 8-week mindfulness-based psychoeducation programme or treatment-as-usual (control) group.

RESULTS

The results of the Generalised Estimating Equations test indicated that the MBPP group showed a significant improvement in reappraisal at a three-month follow-up (β = -6.59, Wald's χ ²=4.55, p=0.033), and a significant reduction in rumination across time. However, the Generalised Estimating Equations indicated no significant difference in rumination and expressive suppression in the MBPP group. Two participants reported having unwanted experiences, including feelings of terror and distress during the mindfulness practice.

CONCLUSION

The MBPP appeared to be effective for improving emotion regulation, which will contribute to future large-scale RCT to confirm the treatment effects in more diverse groups of schizophrenic patients.

Late electrophysiological potentials and emotion in schizophrenia: A meta-analytic review

INTRODUCTION

There is mixed evidence about emotional processing abnormalities in schizophrenia and schizoaffective disorder, with self-reports and clinician ratings indicating significant differences between patients and controls, but studies of in-the-moment, self-reported emotional experience finding only small differences between these groups. The current meta-analysis synthesizes statistics from studies measuring the P3 and LPP, two event-related potential (ERP) components sensitive to attentional allocation, to examine whether patients exhibit ERP response abnormalities to neutral and valenced visual stimuli.

METHODS

Standardized mean amplitudes and standard errors of P3 and/or LPP waveforms (300-2000 ms) in response to neutral and valenced images were calculated for 13 studies (total n = 339 individuals with schizophrenia, 331 healthy controls).

RESULTS

In response to neutral images, there were very small, non-significant differences in ERP amplitudes between patient and control groups (k = 9; Hedges' g = -0.06, 95% CI: -055, 0.43, p = 0.81). In contrast, patients showed a small, significant reduction in ERP amplitudes compared to controls in response to negative images (k = 13; Hedges' g = -0.32, 95% CI: -0.59, -0.05, p = 0.02) and a small, but nonsignificant, reduction in amplitudes in response to positive images (k = 7; Hedges' g = -0.27, 95% CI: -0.71, 0.18, p = 0.24).

CONCLUSIONS AND IMPLICATIONS

The current review indicates that compared to controls, patients have slightly diminished P3 and LPP amplitudes in response to positive and negative stimuli. This small reduction may reflect decreased attention allocation, possibly indicating an abnormality during a distinct stage of early processing related to evaluating the motivational salience of a stimulus.

Nonsocial and social cognition in schizophrenia: current evidence and future directions

Cognitive impairment in schizophrenia involves a broad array of nonsocial and social cognitive domains. It is a core feature of the illness, and one with substantial implications for treatment and prognosis. Our understanding of the causes, consequences and interventions for cognitive impairment in schizophrenia has grown substantially in recent years. Here we review a range of topics, including: a) the types of nonsocial cognitive, social cognitive, and perceptual deficits in schizophrenia; b) how deficits in schizophrenia are similar or different from those in other disorders; c) cognitive impairments in the prodromal period and over the lifespan in schizophrenia; d) neuroimaging of the neural substrates of nonsocial and social cognition, and e) relationships of nonsocial and social cognition to functional outcome. The paper also reviews the considerable efforts that have been directed to improve cognitive impairments in schizophrenia through novel psychopharmacology, cognitive remediation, social cognitive training, and alternative approaches. In the final section, we consider areas that are emerging and have the potential to provide future insights, including the interface of motivation and cognition, the influence of childhood adversity, metacognition, the role of neuroinflammation, computational modelling, the application of remote digital technology, and novel methods to evaluate brain network organization. The study of cognitive impairment has provided a way to approach, examine and comprehend a wide range of features of schizophrenia, and it may ultimately affect how we define and diagnose this complex disorder.

Assessment of 3-dimensional wisdom in schizophrenia: Associations with neuropsychological functions and physical and mental health

Recent decades have seen growing empirical research in wisdom as a complex, trait-based psychological characteristic. Wisdom has been shown to possess individual and societal benefits through associations with health and well-being, but it has not yet been evaluated in people with schizophrenia (PwS). In the current study, we administered a widely used, validated 3-dimensional wisdom scale that includes three interrelated dimensions: cognitive, reflective, and affective. We examined group differences in wisdom, as well as relationships between wisdom and sociodemographics, clinical symptoms, neurocognitive and functional performance, and mental and physical health in 65 stable adult outpatients with chronic schizophrenia or schizoaffective disorder and 96 non-psychiatric comparison participants (NPCPs). Results showed that PwS had lower wisdom scores than NPCPs and that wisdom moderated relationships between diagnostic group and neurocognitive and functional performance; PwS with higher levels of wisdom demonstrated better cognitive performance than did PwS with lower levels of wisdom. In addition, wisdom was positively correlated with performances on multiple neurocognitive tasks in PwS, but not in NPCPs. Finally, reflective wisdom - representing accurate/unbiased introspection and perspective-taking - correlated with all mental health variables in PwS. Our results were limited by a cross-sectional design, but suggest that wisdom, especially reflective wisdom, may be associated with better cognitive performance and better physical and mental health in PwS. It is conceivable that interventions to enhance wisdom may have broad cognitive and mental and physical health benefits in individuals with chronic psychotic disorders.

Many ways to forget - Neurophysiology of directed forgetting mechanisms in schizophrenia

Numerous studies have shown dysfunctional mechanism of interaction between bottom-up emotional and top-down cognitive processes in persons with schizophrenia (SCZ). During the emotional directed forgetting (DF) paradigm participants have to apply volitional mechanisms to resist automatic emotional enhancement of the memory. Here we sought to compare mechanisms underlying emotional DF in SCZ and in healthy persons (HC). Eighteen SCZ and eighteen HC completed a DF paradigm with neutral and negative pictures. EEG was recorded during study and test phase of the task. We analyzed both the behavioral outcomes and event-related potential components, indicating emotional enhancement of memory (Late Positive Potential elicited by pictures) and DF strategies (N2/P3 elicited by forget/remember cues during study-phase; "old/new" and "reversed old/new" effects during test-phase of the task). Directed forgetting effects and emotional enhancement of memory were observed in both groups, even despite overall lower recognition rates in SCZ. Furthermore, cue presentation elicited similar pattern of N2/P3s in SCZ and in HC. However, "reversed old/new" effect was observed only in HC for negative stimuli. Patients may show similar reaction to affective stimuli as healthy controls during the emotional DF task. However, further investigation is needed to elicit the specific mechanisms underlying the DF strategies in SCZ.

Affective modulation of target detection in deficit and non-deficit schizophrenia

Emotional deficits are an integral feature of schizophrenia (SZ), but our understanding of these deficits is limited. In the present study, we examined whether the severity of emotional deficits reflects difficulty in the cognitive processing of affectively valenced stimuli. Healthy controls (HC; N = 170) and stable outpatients with SZ (N = 245), characterized as either deficit syndrome (DS; N = 62) or non-deficit syndrome (NDS; N = 183), completed an Affective Go/NoGo task requiring discrimination of positively, negatively or neutrally valenced words. Accuracy (d') and response bias (c) were calculated for each of the three conditions, and a series of ANOVAs were carried out to examine group differences. Examination of accuracy revealed significant main effects of group and valence and a significant valence × group interaction, indicating that while affective valence impacted accuracy for the HC and NDS groups, the DS group maintained the same low level of accuracy across all levels of affective valence. Examination of response bias also revealed significant main effects of group and valence and a significant valence × group interaction. Specifically, within the HC and NDS groups, response bias did not differ between negatively and positively valenced words while response bias in the DS group was lowest for neutral, higher for negatively valenced and higher still for positively valenced words. These results suggest that emotional deficits in DS may be directly related to deficits in processing affective information. Moreover, although this deficit is observed across both positively and negatively valenced stimuli, it is most pronounced for positively valenced material.

Acute stress modifies oscillatory indices of affective processing: Insight on the pathophysiology of schizophrenia spectrum disorders

OBJECTIVE

The current study evaluated the differential impact of acute psychosocial stress exposure on oscillatory correlates of affective processing in control participants and patients with schizophrenia spectrum disorders (SCZ) to elucidate the stress-mediated pathway to psychopathology.

METHODS

EEG was recorded while 21 control participants and 21 patients with SCZ performed emotional framing tasks (assessing a key aspect of emotion regulation (ER)) before and after a laboratory stress challenge (Trier Social Stress Test). EEG spectral perturbations evoked in response to neutral and aversive stimuli (presented with positive or negative contextual cues) were extracted in theta (4-8 Hz) and beta (12-30 Hz) frequencies.

RESULTS

Patients demonstrated aberrant theta and beta oscillatory activity, with impaired frontal theta-mediated framing and beta-derived motivated attention processes relative to controls. Following stress exposure, controls exhibited impaired frontal theta-mediated emotional framing, similar to the oscillatory profile observed in patients before stress.

CONCLUSIONS

The acute stress-induced oscillatory changes observed in controls were persistently present in patients, indicating an inefficiency of fronto-limbic adaptation to stress exposure.

SIGNIFICANCE

Results provide novel insight on the electrophysiological correlates of arousal and affect regulation, which are core homogeneous symptom dimensions shared across neuropsychiatric disorders, and shed light on putative mechanisms in the translation of stress into psychopathology.

A multicomponent approach toward understanding emotion regulation in schizophrenia

OBJECTIVES

Emotion deficits are well documented in people with schizophrenia. Far less is known about their ability to implement emotion regulation strategies. We sought to explore whether people with schizophrenia can modify their emotion responses similar to controls.

METHODS

People with (n = 25) and without (n = 21) schizophrenia were instructed to amplify positive-emotion expression, reappraise negative emotion experience, and suppress physiological response. Multiple components of emotion response were measured (experience, expression, and physiology).

RESULTS

Although people with schizophrenia showed increased positive expressivity following amplification and decreased negative emotion experience following reappraisal, overall, they expressed less positive emotion and experienced more negative emotion compared with controls. Neither group was effective at physiological suppression.

CONCLUSIONS

Together these findings suggest that people with schizophrenia can engage in amplification and reappraisal when explicitly instructed to do so, albeit additional practice may be necessary to modify emotion responses to levels similar to controls.

An ecological momentary assessment evaluation of emotion regulation abnormalities in schizophrenia

BACKGROUND

Prior studies using self-report questionnaires and laboratory-based methods suggest that schizophrenia is characterized by abnormalities in emotion regulation (i.e. using strategies to increase or decrease the frequency, duration, or intensity of negative emotion). However, it is unclear whether these abnormalities reflect poor emotion regulation effort or adequate effort, but limited effectiveness. It is also unclear whether dysfunction results primarily from one of the three stages of the emotion regulation process: identification, selection, or implementation.

METHOD

The current study used ecological momentary assessment (EMA) to address these questions in the context of everyday activities. Participants included 28 outpatients diagnosed with schizophrenia (SZ) and 28 demographically matched healthy controls (CN) who completed 6 days of EMA reports of in-the-moment emotional experience, emotion regulation strategy use, and context.

RESULTS

Results indicated that SZ demonstrated adequate emotion regulation effort, but poor effectiveness. Abnormalities were observed at each of the three stages of the emotion regulation process. At the identification stage, SZ initiated emotion regulation efforts at a lower threshold of negative emotion intensity. At the selection stage, SZ selected more strategies than CN and strategies attempted were less contextually appropriate. At the implementation stage, moderate to high levels of effort were ineffective at decreasing negative emotion.

CONCLUSIONS

Findings suggest that although SZ attempt to control their emotions using various strategies, often applying more effort than CN, these efforts are unsuccessful; emotion regulation abnormalities may result from difficulties at the identification, selection, and implementation stages.

Insight and emotion regulation in schizophrenia: A brain activation and functional connectivity study

Background

Insight is impaired in the majority of schizophrenia patients. The exact neural correlates of impaired insight remain unclear. We assume that the ability to regulate emotions contributes to having good clinical insight, as patients should be able to regulate their emotional state in such a way that they can adapt adequately in order to cope with impaired functioning and negative stigma associated with a diagnosis of schizophrenia. Numerous studies have shown emotional dysregulation in schizophrenia. We investigated the association between insight and brain activation and connectivity during emotion regulation.

Methods

Brain activation during emotion regulation was measured with functional MRI in 30 individuals with schizophrenia. Two emotion regulation strategies were examined: cognitive reappraisal and expressive suppression. Clinical insight was measured with the Schedule for the Assessment of Insight – Expanded, and cognitive insight was measured with the Beck Cognitive Insight Scale. Whole brain random effects multiple regression analyses were conducted to assess the relation between brain activation during emotion regulation and insight. Generalized psychophysiological interaction (gPPI) was used to investigate the relation between task-related connectivity and insight.

Results

No significant associations were found between insight and neural correlates of cognitive reappraisal. For clinical insight and suppression, significant positive associations were found between symptom relabeling and activation in the left striatum, thalamus and insula, right insula and caudate, right pre- and postcentral gyrus, left superior occipital gyrus and cuneus and right middle and superior occipital gyrus and cuneus. Furthermore, reduced clinical insight was associated with more connectivity between midline medial frontal gyrus and right middle occipital gyrus. For cognitive insight and suppression, significant positive associations were found between self-reflectiveness and activation in pre- and postcentral gyrus and left middle cingulate gyrus.

Conclusions

Our results suggest an association between the capacity to relabel symptoms and activation of brain systems involved in cognitive-emotional control and visual processing of negative stimuli. Furthermore, poorer self-reflectiveness may be associated with brain systems subserving control and execution.

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We examined the association between emotion regulation and insight in schizophrenia.

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Patients with poorer insight engage different neural pathways during suppression.

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This finding was strengthened by connectivity measures of corresponding brain areas.

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No relationship between cognitive reappraisal and insight was found.

Anhedonia reflects impairment in making relative value judgments between positive and neutral stimuli in schizophrenia

Anhedonia (i.e., diminished capacity to experience pleasure) has traditionally been viewed as a core symptom of schizophrenia (SZ). However, modern laboratory-based studies suggest that this definition may be incorrect, as hedonic capacity may be intact. Alternative conceptualizations have proposed that anhedonia may reflect an impairment in generating mental representations of affective value that are needed to guide decision-making and initiate motivated behavior. The current study evaluated this hypothesis in 42 outpatients with SZ and 19 healthy controls (CN) who completed two tasks: (a) an emotional experience task that required them to indicate how positive, negative, and calm/excited they felt in response to a single emotional or neutral photograph; (b) a relative value judgment task where they selected which of 2 photographs they preferred. Results indicated that SZ and CN reported similar levels of positive emotion and arousal in response to emotional and neutral stimuli; however, SZ reported higher negative affect for neutral and pleasant stimuli than CN. In the relative value judgment task, CN displayed clear preference for stimuli differing in valence; however, SZ showed less distinct preferences for positive over neutral stimuli. Findings suggest that although in-the-moment experiences of positive emotion to singular stimuli may be intact in SZ, the ability to make relative value judgments that are needed to guide decision-making is impaired. Original conceptualizations of anhedonia as a diminished capacity for pleasure in SZ may be inaccurate; anhedonia may more accurately reflect a deficit in relative value judgment that results from impaired value representation.

A Systematic Review of Trials Targeting Depression and Anxiety in Patients With Delusions

Abstract. Negative affect and impaired emotion regulation skills are prevalent in patients with delusions and contribute to delusion formation and maintenance. This review evaluates existing research on interventions targeting negative affect and emotional processes as a causal mechanism on the pathway to delusions. A MEDLINE and PsycINFO search identified 7,909 articles. Five studies with randomized-controlled designs and three with uncontrolled designs met the inclusion criteria. Interventions comprised cognitive-behavioral and compassion-focused techniques. Overall, the review studies found positive intervention effects on negative affect and delusions. Where significant, controlled effect sizes ranged from small to large for negative affect and from moderate to large for delusions. Thus, existing research indicates that negative affect in patients with delusions can be modified by psychological therapy and points toward a carryover effect from the reduction of negative affect to a reduction of delusions. More large-scale randomized-controlled studies are needed to be able to draw valid conclusions on which types of interventions are most beneficial.

Impaired regulation of emotional distractors during working memory load in schizophrenia

Schizophrenia (SZ) patients exhibit deficits in emotion regulation that affect their daily functioning. There is evidence that the prefrontal cortex plays an important role in emotion regulation. However, it remains unclear how this brain region is involved in emotion regulation deficits in SZ, and how such deficits impact performance on cognitively demanding tasks. We examined how happy and fearful emotional distractors impact performance on working memory (WM) tasks of varying difficulty (0-back, 2-back), and brain activity using fMRI. Participants were 20 patients with SZ and 20 healthy controls (HC) matched on age, sex, race, and IQ. A significant 3-way interaction showed that SZ patients had lower performance compared to HC when exposed to fearful and happy distractors, but only during the 2-back task. Second-level fMRI between-group analysis revealed that compared to SZ patients, HC showed significantly greater increase in brain activity with WM load in the left IFG (BA 45) when exposed to fearful distractors. Less brain activity in this region was also associated with reduction in SZ patients' performance during higher WM load and the presence of fearful distractors. SZ patients had difficulty in performing a WM task when regulating emotions, and they failed to show the emotion-specific modulation of the left IFG observed in HC. These results suggest that SZ patients have difficulty with emotion regulation demands during effortful cognitive tasks. This also provides us with potential insight on how emotion regulation could be rehabilitated in SZ using cognitive training.

Exploring deficient emotion regulation in adult ADHD: electrophysiological evidence

Emotional dysregulation (ED) is being increasingly recognized as a core feature of attention-deficit/hyperactivity disorder (ADHD), but the pathophysiological underpinnings remain unclear. In this study, we provide meaningful electrophysiological evidence of ED in adult patients with ADHD (n = 39) compared to healthy controls (n = 40) by exploring the electrophysiological correlates of the emotion regulation strategies reappraisal, distraction, and expressive suppression. Event-related potentials (ERPs) were recorded during passive viewing of neutral and negative images, as well as during emotion regulation. The patients with ADHD exhibited increased frontal late positive potential (LPP) amplitudes during passive viewing of the aversive images and during emotion regulation. Compared with the healthy controls, a subgroup of medication-naïve patients with ADHD (n = 25) also exhibited larger centroparietal LPP amplitudes and provided more negative ratings of the aversive and neutral images. Both the frontal and centroparietal LPP amplitudes were associated with ADHD symptom severity. However, no significant deficit in LPP modulation during emotion regulation was found. These findings strongly support the clinical observation of increased emotional responsivity toward negative stimuli and difficulty during the implementation of emotion regulation strategies and thus encourage the implementation of emotion regulation modules in the treatment of adult patients with ADHD.

Emotion Regulation Predicts Everyday Emotion Experience and Social Function in Schizophrenia

While recent evidence has pointed to disturbances in emotion regulation strategy use in schizophrenia, few studies have examined how these regulation strategies relate to emotionality and social behavior in daily life. Using ecological momentary assessment (EMA), we investigated the relationship between emotion regulation, emotional experience and social interaction in the daily lives of individuals with schizophrenia. Participants (N=30) used mobile phones to complete online questionnaires reporting their daily emotional experience and social interaction. Participants also completed self-report measures of habitual emotion regulation. Hierarchical linear modeling revealed that self-reported use of cognitive reappraisal and savoring of emotional experiences were related to greater positive emotion in daily life. In contrast, self-reported suppression was related to greater negative emotion, reduced positive emotion and reduced social interaction in daily life. These findings suggest that individual differences in habitual emotion regulation strategy usage have important relationships to every day emotional and social experiences in schizophrenia.

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

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

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

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

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

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