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Li X, Zhang YT, Li XH, Wang Y, Peng M, Myin-Germeys I. Abnormalities in emotion regulation are associated with negative, but not positive or disorganized schizotypy: An experience sampling study. Schizophr Res 2024; 270:165-171. [PMID: 38917553 DOI: 10.1016/j.schres.2024.06.018] [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: 01/14/2024] [Revised: 05/24/2024] [Accepted: 06/15/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Schizotypy, a multidimensional construct with positive, negative, and disorganized dimensions, represents a vulnerability marker for the development of schizophrenia. Although there has been increasing evidence linking schizotypy to emotion regulation (ER) deficits, the specific association between different schizotypal dimensions and alterations in ER strategy use in daily life remains poorly understood. METHODS Using the experience sampling method (ESM), the present study examined the associations between positive, negative, and disorganized schizotypy and ER strategy use in daily life in a nonclinical young adult sample (N = 258). Participants were instructed to report their ER strategy use 5 times a day for 14 days. Four adaptive ER strategies (reflection, reappraisal, social sharing, and distraction) and two maladaptive ER strategies (suppression and rumination) were included. RESULTS Multilevel modeling analyses showed that positive schizotypal traits predicted greater use of adaptive ER strategies, while negative schizotypal traits predicted less use of adaptive ER strategies and more frequent use of emotional suppression in daily life. No associations between disorganized schizotypal traits and any ER strategy use were found. CONCLUSION Schizotypy dimensions are differentiated by preferences for different ER strategies in daily life. The findings suggest a strong association between negative schizotypy and notable dysfunctions in ER, emphasizing the significance of negative schizotypy as a vulnerability factor for psychosis.
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Affiliation(s)
- Xu Li
- Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Wuhan, China; Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China; Center for Contextual Psychiatry, Psychiatry Research Group, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Yu-Ting Zhang
- Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Wuhan, China; Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Xu-Hua Li
- Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Wuhan, China; Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
| | - Ming Peng
- Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Wuhan, China; Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China.
| | - Inez Myin-Germeys
- Center for Contextual Psychiatry, Psychiatry Research Group, Department of Neurosciences, KU Leuven, Leuven, Belgium
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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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Riehle M, Straková A, Lincoln TM. Emotional Experience of People With Schizophrenia and People at Risk for Psychosis: A Meta-Analysis. JAMA Psychiatry 2024; 81:57-66. [PMID: 37755868 PMCID: PMC10535019 DOI: 10.1001/jamapsychiatry.2023.3589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/12/2023] [Indexed: 09/28/2023]
Abstract
Importance Psychotic symptoms are associated with subjective reports of aberrant emotion, such as excessive fear or anhedonia, but whether these aberrations reflect aberrant emotional experience of normative stimuli is uncertain both for individuals with schizophrenia and those at risk for psychosis. Objective To provide a meta-analysis of study samples of emotional experience in individuals with schizophrenia and those at risk for psychosis as assessed in laboratory-based emotion-induction studies. Data Sources MEDLINE and PsycINFO databases were searched for articles published from January 1986 and Google Scholar citations of a relevant earlier meta-analysis until August 2022. Reference lists were manually searched for additional studies. Study Selection Included studies measured positive or negative emotional experience in response to standardized emotionally evocative stimuli and compared participants diagnosed with schizophrenia or participants at risk for psychosis with healthy controls. Data Extraction and Synthesis The meta-analysis was registered with PROSPERO and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. Data were extracted by 2 independent coders, and random-effects analyses were conducted. Main Outcomes and Measures Outcomes were 3 scales of emotional experience (unipolar positive emotion, unipolar negative emotion, bipolar valence), analyzed separately for pleasant, neutral, and unpleasant stimuli. A meta-analysis was conducted for differences between the 2 clinical groups combined and controls. Subgroup differences (schizophrenia vs at risk) and the influence of several other variables were tested in moderator analyses. Results This systematic review and meta-analysis included data from 111 studies and 6913 participants (schizophrenia: 2848 [41.2%]; at risk: 877 [12.7%]; healthy controls: 3188 [46.1%]). Compared with controls, people with schizophrenia and those at risk for psychosis experienced pleasant stimuli as less positive (unipolar positive: standardized mean difference [SMD] Hedges g = -0.19; P =.001; bipolar valence: SMD Hedges g = -0.28; P <.001) and more negative (Hedges g = 0.52; P <.001), neutral stimuli as more negative (Hedges g = 0.55; P <.001), and unpleasant stimuli as both more positive (unipolar positive: SMD Hedges g = 0.23; P =.005; bipolar valence: Hedges g = 0.12; P =.01) and more negative (Hedges g = 0.22; P <.001). Moderator analyses indicated a less aberrant emotional experience for odors than for visual stimuli (unipolar negative, pleasant z score = -2.97; P =.003; unipolar negative, neutral z score = -2.70; P =.007), an association between higher negative symptoms and diminished positive emotion for pleasant stimuli in schizophrenia (z score = -2.98; P =.003), and that subgroup differences were limited to neutral stimuli. Conclusions and Relevance Results suggest a pattern of aberrant emotional experience of normative stimuli in schizophrenia and that this already was observable before disorder onset. In particular, the aberrant experience of pleasant stimuli needs to be considered as an intervention target.
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Affiliation(s)
- Marcel Riehle
- Institute for Psychology, Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany
| | - Alexandra Straková
- Department of Psychology, Comenius University in Bratislava, Bratislava, Slovakia
| | - Tania M. Lincoln
- Institute for Psychology, Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany
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Peng P, Wang D, Wang Q, Zhou Y, Hao Y, Chen S, Wu Q, Liu T, Zhang X. Alexithymia in Chinese patients with chronic schizophrenia: Prevalence, clinical correlates, and relationship with neurocognition and empathy. Asia Pac Psychiatry 2023; 15:e12547. [PMID: 37635651 DOI: 10.1111/appy.12547] [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: 03/21/2023] [Revised: 07/30/2023] [Accepted: 08/16/2023] [Indexed: 08/29/2023]
Abstract
INTRODUCTION Alexithymia is highly prevalent and strongly related to adverse consequences in patients with schizophrenia. However, its associated factors remain largely unexplored. The present study aimed to determine the prevalence of alexithymia and its association with sociocultural characteristics, clinical symptoms, neurocognition, and empathy in 854 Chinese patients with schizophrenia. METHOD Demographic information was collected through a self-designed questionnaire. Alexithymia was assessed by the Toronto Alexithymia Scale (TAS-20). We assessed clinical symptoms, neurocognition, and empathy via the following instruments: Positive and Negative Syndrome Scale, Repeatable Battery for the Assessment of Neuropsychological Status, and Interpersonal Reactivity Index. A multiple logistic regression model was conducted to determine the independent correlates of alexithymia. RESULTS Approximately one-third (n = 277, 32%) of patients with schizophrenia had alexithymia. Patients with alexithymia had significantly more severe negative symptoms, neurocognition, and empathy impairment than patients without alexithymia. Being male, negative symptoms, personal distress, empathic concern, and language functioning were independently associated with alexithymia. DISCUSSION Our findings demonstrate a high prevalence of alexithymia and its strong association with clinical symptoms, neurocognition, and empathy, which calls for timely screening and intervention for alexithymia in patients with schizophrenia. Targeting impaired language function, negative symptoms, and impaired affective empathy might help reduce alexithymia and its related negative consequences.
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Affiliation(s)
- Pu Peng
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Dongmei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Qianjin Wang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yanan Zhou
- Department of Psychiatry, Hunan Brain Hospital (Hunan Second People's Hospital), Changsha, China
| | - Yuzhu Hao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Shubao Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Qiuxia Wu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Tieqiao Liu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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Steenhuis LA, Harms T, Nauta MH, Bartels-Velthuis AA, Albers CJ, Aleman A, Vos M, Pijnenborg GHM, van den Berg D, Palstra EC, Wigman JTW, Booij SH. The dynamics of social activation and suspiciousness in individuals at ultra-high risk for psychosis. Schizophr Res 2023; 262:67-75. [PMID: 37925753 DOI: 10.1016/j.schres.2023.10.012] [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: 09/30/2022] [Revised: 04/25/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Social functioning is often impaired during the ultra-high risk (UHR) phase for psychosis, but group-level studies regarding the role of social functioning in transition to psychosis are inconsistent. Exploring the inter-individual differences which underlie the association between social functioning and psychotic symptoms in this phase could yield new insights. OBJECTIVE To examine the idiographic and dynamic association between social activation and suspiciousness in individuals at UHR for psychosis using time-series analysis. METHODS Twenty individuals at UHR for psychosis completed a diary application every evening for 90 days. Two items on social activation (quantity: 'time spent alone' and quality: 'feeling supported') and two items on suspiciousness ('feeling suspicious' and 'feeling disliked') were used. Time series (T = 90) of each individual were analyzed using vector auto regression analysis (VAR), to estimate the lagged (over 1 day) effect of social activation on suspiciousness, and vice versa, as well as their contemporaneous associations. RESULTS Heterogeneous person-specific associations between social activation and suspiciousness were found in terms of strength, direction and temporal aspects. CONCLUSIONS The association between social activation and suspiciousness differs amongst individuals who are at UHR for psychosis. These findings underline the importance of tailoring psychosocial interventions to the individual. Future studies may examine whether using results of single-subject studies in clinical practice to personalize treatment goals leads to better treatment outcomes.
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Affiliation(s)
- Laura A Steenhuis
- University of Groningen, Faculty of Behavioural and Social Sciences, Department of Clinical and Developmental Neuropsychology, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands; GGZ Drenthe, Department of Psychotic Disorders, Dennenweg 9, 9404 LA Assen, the Netherlands.
| | - Tim Harms
- University of Groningen, Faculty of Behavioural and Social Sciences, Department of Clinical and Developmental Neuropsychology, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands
| | - Maaike H Nauta
- University of Groningen, Faculty of Behavioural and Social Sciences, Department of Clinical and Developmental Neuropsychology, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands
| | - Agna A Bartels-Velthuis
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands
| | - Casper J Albers
- University of Groningen, Faculty of Behavioural and Social Sciences, Department of Psychometrics & Statistics, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands
| | - André Aleman
- University of Groningen, Faculty of Behavioural and Social Sciences, Department of Clinical and Developmental Neuropsychology, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Maarten Vos
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands
| | - Gerdina H M Pijnenborg
- University of Groningen, Faculty of Behavioural and Social Sciences, Department of Clinical and Developmental Neuropsychology, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands; GGZ Drenthe, Department of Psychotic Disorders, Dennenweg 9, 9404 LA Assen, the Netherlands
| | - David van den Berg
- VU University and Amsterdam Public Health Research, Department of Clinical Psychology, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands; Parnassia Psychiatric Institute, Department of Psychosis Research, Zoutkeetsingel 40, 2512 HN The Hague, the Netherlands
| | - Eline C Palstra
- VU University and Amsterdam Public Health Research, Department of Clinical Psychology, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands; Parnassia Psychiatric Institute, Department of Psychosis Research, Zoutkeetsingel 40, 2512 HN The Hague, the Netherlands
| | - Johanna T W Wigman
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Neuroscience, Antonius Deusinglaan 1, 9713 AV, Groningen, the Netherlands
| | - Sanne H Booij
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, Antonius Deusinglaan 1, 9713 AV, Groningen, the Netherlands
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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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So SHW, Chau AKC, Chung LKH, Leung CM, Chong GH, Chang WC, Mak AD, Chan SS, Lee S, Sommer IE. Moment-to-moment affective dynamics in schizophrenia and bipolar disorder. Eur Psychiatry 2023; 66:e67. [PMID: 37544924 PMCID: PMC10594258 DOI: 10.1192/j.eurpsy.2023.2438] [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: 05/01/2023] [Revised: 06/20/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Affective disturbances in schizophrenia and bipolar disorder may represent a transdiagnostic etiological process as well as a target of intervention. Hypotheses on similarities and differences in various parameters of affective dynamics (intensity, successive/acute changes, variability, and reactivity to stress) between the two disorders were tested. METHODS Experience sampling method was used to assess dynamics of positive and negative affect, 10 times a day over 6 consecutive days. Patients with schizophrenia (n = 46) and patients with bipolar disorder (n = 46) were compared against age-matched healthy controls (n = 46). RESULTS Compared to controls, the schizophrenia group had significantly more intense momentary negative affect, a lower likelihood of acute changes in positive affect, and reduced within-person variability of positive affect. The bipolar disorder group was not significantly different from either the schizophrenia group or the healthy control group on any affect indexes. Within the schizophrenia group, level of depression was associated with weaker reactivity to stress for negative affect. Within the bipolar disorder group, level of depression was associated with lower positive affect. CONCLUSIONS Patients with schizophrenia endured a more stable and negative affective state than healthy individuals, and were less likely to be uplifted in response to happenings in daily life. There is little evidence that these affective constructs characterize the psychopathology of bipolar disorder; such investigation may have been limited by the heterogeneity within group. Our findings supported the clinical importance of assessing multiple facets of affective dynamics beyond the mean levels of intensity.
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Affiliation(s)
- Suzanne Ho-wai So
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - Anson Kai Chun Chau
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
- Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Chung-ming Leung
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - George H.C. Chong
- Department of Clinical Psychology, Kwai Chung Hospital, Hong Kong, China
| | - Wing Chung Chang
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
| | - Arthur D.P. Mak
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
| | - Sandra S.M. Chan
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
| | - Sing Lee
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
| | - Iris E. Sommer
- Department of Psychiatry, University Medical Centre Groningen, The Netherlands
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Strakeljahn F, Lincoln TM, Hennig T, Schlier B. The use of adaptive emotion regulation strategies in people with attenuated psychotic symptoms - Results from a two-week diary study. Schizophr Res 2023; 255:233-238. [PMID: 37028204 DOI: 10.1016/j.schres.2023.03.037] [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: 05/26/2022] [Revised: 02/17/2023] [Accepted: 03/18/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Prior research has shown that negative emotion constitutes a trigger for psychosis. This effect is further amplified by using maladaptive emotion regulation strategies. In contrast, the role of adaptive emotion regulation strategies is less clear despite its potential for informing interventions and prevention efforts. In this study, we investigated whether the decreased use of adaptive emotion regulation strategies in daily life is associated with an elevated risk of psychosis. METHODS Participants reporting a lifetime prevalence of attenuated psychotic symptoms (AS; n = 43) and comparison participants without attenuated psychotic symptoms (n = 40) completed a 14-day diary study with one daily assessment of adaptive emotion regulation (ER) strategies ranging from tolerance-based ER-strategies (e.g., understanding, constructively directing attention) to change-focused ER-strategies (e.g., modification, effective self-support). We tested for group differences in adaptive ER-strategies use with multilevel models. RESULTS AS used multiple tolerance-based adaptive ER-strategies (acceptance, understanding, clarity, directing attention) less frequently in daily life. However, only a single change-focused adaptive ER-strategy (modification) showed consistently lower utilization rates in AS. CONCLUSION People with an elevated risk of psychosis use various adaptive ER-strategies focusing on comprehending and accepting negative emotions less frequently. Fostering these strategies with targeted interventions could promote resilience against transitioning into psychosis.
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Affiliation(s)
- Felix Strakeljahn
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany.
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany
| | - Timo Hennig
- Inclusive Education, Faculty of Human Sciences, Universität Potsdam, Karl-Liebknecht-Straße 24-25, 14476 Potsdam, Germany
| | - Björn Schlier
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany
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Gupta T, Antezana L, Porter C, Mayanil T, Bylsma LM, Maslar M, Horton LE. Skills program for awareness, connectedness, and empowerment: A conceptual framework of a skills group for individuals with a psychosis-risk syndrome. Front Psychiatry 2023; 14:1083368. [PMID: 37025348 PMCID: PMC10072161 DOI: 10.3389/fpsyt.2023.1083368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/10/2023] [Indexed: 03/08/2023] Open
Abstract
Intervention strategies for those diagnosed with psychotic disorders such as schizophrenia can be effective in reducing symptoms and improving quality of life. While strides have been made in developing prevention and intervention strategies earlier on in the disease progression, among those at clinical high-risk (CHR) for psychosis, challenges with heterogeneity can limit symptom and diagnosis specific treatment. Here, we discuss a newly developed therapy skills group called the Skills Program for Awareness, Connectedness, and Empowerment (SPACE) that integrates different types of behavioral skills - standard and radically open dialectical behavioral therapy as well as cognitive behavioral therapy - for CHR youth between the ages of 13-18 years. With the diathesis-stress framework serving as a foundation, the intervention is divided into three stages. These stages target specific signs and symptoms contributing to the progression of CHR symptoms. Stage 1 targets stress (with the goal of developing awareness and reducing distress), stage 2 targets self-disturbances (with a goal of increasing self-connectedness), and stage 3 targets social connectedness (with a goal of improving social domains of functioning). The focus of this article is to introduce the theoretical framework underlying the pilot skills group and discuss ongoing progress. Clinical Trial Registration NCT05398120; https://clinicaltrials.gov/ct2/show/NCT05398120.
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Affiliation(s)
- Tina Gupta
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Ligia Antezana
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Christian Porter
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Tushita Mayanil
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Lauren M. Bylsma
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Michael Maslar
- The Family Institute at Northwestern University, Evanston, IL, United States
| | - Leslie E. Horton
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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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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11
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Macfie WG, Spilka MJ, Bartolomeo LA, Gonzalez CM, Strauss GP. Emotion regulation and social knowledge in youth at clinical high-risk for psychosis and outpatients with chronic schizophrenia: Associations with functional outcome and negative symptoms. Early Interv Psychiatry 2023; 17:21-28. [PMID: 35362242 PMCID: PMC10084209 DOI: 10.1111/eip.13287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/17/2022] [Accepted: 03/13/2022] [Indexed: 01/21/2023]
Abstract
AIM Previous studies indicate that several aspects of social cognition are associated with poor social and vocational outcome in the chronic phase of psychosis. However, it is less clear whether specific aspects of social cognition are impaired in those at clinical high-risk (CHR) for psychosis and associated with functioning. The current study evaluated two understudied components of social cognition, emotion regulation knowledge and social knowledge, to determine whether CHR and chronic schizophrenia (SZ) samples demonstrated comparable magnitudes of impairment and associations with functioning. METHODS Two studies were conducted. Study 1 included n = 98 outpatients with chronic SZ and n = 88 demographically matched healthy controls (CN). Study 2 included 30 CHR and 30 matched CN participants. In both studies, participants completed the emotion management and social management subtests of the Mayer-Salovey-Caruso Emotional Intelligence Test to assess emotion regulation knowledge and social knowledge, respectively. A battery of clinical interviews was also administered, including measures of: role and social functioning, positive symptoms, negative symptoms, disorganization and general symptoms. RESULTS Individuals with SZ demonstrated lower emotion management and social management scores than CN participants. CHR demonstrated lower scores in social management than CN but did not display deficits in emotion management. In both studies, reduced social knowledge was associated with worse functioning and negative symptoms. CONCLUSIONS Findings indicate that deficits in social knowledge are transphasic across the SZ spectrum, and are associated with clinical functioning. Social knowledge may be a novel treatment target for psychosocial interventions.
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Affiliation(s)
- William G Macfie
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Michael J Spilka
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Lisa A Bartolomeo
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | | | - Gregory P Strauss
- Department of Psychology, University of Georgia, Athens, Georgia, USA
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12
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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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13
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Wastler HM, Núñez D. Psychotic experiences, emotion regulation, and suicidal ideation among Chilean adolescents in the general population. Front Psychiatry 2022; 13:983250. [PMID: 36465305 PMCID: PMC9710630 DOI: 10.3389/fpsyt.2022.983250] [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: 06/30/2022] [Accepted: 10/24/2022] [Indexed: 11/18/2022] Open
Abstract
Psychotic experiences are associated with increased risk for suicide. Despite this well-established finding, very little is known about factors that contribute to this relationship. The current study investigated the relationship between psychotic experiences, emotion regulation, and suicidal ideation among 1,590 Chilean adolescents in the general population. Participants completed self-report measures of psychotic experiences (Community Assessment of Psychic Experiences), emotion regulation (Emotion Regulation Questionnaire), depression (Patient Health Questionnaire-9), and suicidal ideation (Columbia Suicide Severity Rating Scale). Statistical analyses included Mann-Whitney U tests, point-biserial correlations, logistic regression, and moderation analyses. Results suggest that paranoid ideation, bizarre experiences, and perceptual abnormalities were moderately associated with suicidal ideation. Additionally, greater expressive suppression and cognitive reappraisal were associated with suicidal ideation. Results from the logistic regression indicate that paranoid ideation, perceptual abnormalities, and expressive suppression have the strongest relationship with suicidal ideation, even when controlling for depression and relevant demographic variables. Additionally, paranoid ideation interacted with expressive suppression to predict suicidal ideation, with expressive suppression having the strongest relationship with suicidal ideation when paranoid ideation was low to moderate. Taken together, these findings support the broader literature suggesting that emotion regulation might be a transdiagnostic risk factor for suicidal ideation. Additional longitudinal research is needed to examine whether expressive suppression and other maladaptive emotion regulation strategies serve as a mechanism for suicidal ideation both in the general population and among individuals with psychotic experiences.
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Affiliation(s)
- Heather M. Wastler
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, United States
| | - Daniel Núñez
- Faculty of Psychology, Universidad de Talca, Talca, Chile
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile
- Programa de Investigación Asociativa, Faculty of Psychology, Centro de Investigación en Ciencias Cognitivas, Universidad de Talca, Talca, Chile
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14
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Interactions between the cortical midline structures and sensorimotor network track maladaptive self-beliefs in clinical high risk for psychosis. SCHIZOPHRENIA 2022; 8:74. [PMID: 36114173 PMCID: PMC9481626 DOI: 10.1038/s41537-022-00279-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/17/2022] [Indexed: 12/02/2022]
Abstract
Individuals at clinical high risk for psychosis (CHR) report a maladaptive self-concept—with more negative and less positive self-beliefs—linked to clinical symptoms and functional impairment. Alterations have also been reported in brain networks associated with intrinsic (cortical midline structures, CMS) and extrinsic (sensorimotor network, SMN) self-processing. Theoretical accounts of multiple levels of self-experience in schizophrenia suggest that interactions between these networks would be relevant for self-beliefs. This study tested whether self-beliefs related to resting-state functional connectivity within and between the CMS and SMN. Participants were 56 individuals meeting CHR criteria and 59 matched healthy community participants (HC). Pearson correlations examined potential mediators and outcomes. The CHR group reported more negative and less positive self-beliefs. Greater resting-state functional connectivity between the posterior CMS (posterior cingulate cortex) and the SMN was associated with less positive self-beliefs in CHR, but more positive self-beliefs in HC. Attenuated negative symptoms and poorer social functioning were associated with CMS-SMN connectivity (trend level after FDR-correction) and self-beliefs. Reduced connectivity between the left and right PCC was associated with lower positive self-beliefs in CHR, although this effect was specific to very low levels of positive self-beliefs. Left-right PCC connectivity did not correlate with outcomes. Dynamic interactions between intrinsic and extrinsic self-processing supported positive self-beliefs in typically developing youth while undermining positive self-beliefs in CHR youth. Implications are discussed for basic self-fragmentation, narrative self-related metacognition, and global belief updating. Interventions for self-processing may be beneficial in the CHR syndrome.
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15
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Spang KS, Hagstrøm J, Ellersgaard D, Christiani C, Hemager N, Burton BK, Greve AN, Rohr K, Gantriis D, Vangkilde S, Mors O, Nordentoft M, Obel C, Plessen KJ, Jepsen JRM, Thorup AAE. Emotion regulation in 7-year-old children with familial high risk for schizophrenia or bipolar disorder compared to controls - The Danish High Risk and Resilience Study - VIA 7, a population-based cohort study. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:1103-1118. [PMID: 36029104 DOI: 10.1111/bjc.12382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/25/2022] [Accepted: 06/29/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Emotion regulation is a predictor of overall life outcome. Problems of emotion regulation are associated with multiple psychiatric disorders and could be a potential treatment target for improving well-being and functioning. Children at familial high risk of severe mental illness have a markedly increased risk of various psychopathology and constitute a group at significant risk of emotion regulation problems. Investigations of emotion regulation in children at familial high risk of severe mental illness are sparse. METHODS We applied an instrument for assessing emotion regulation, the Tangram Emotion Coding Manual (TEC-M), to a population-based cohort of 522 7-year-old children born to parents diagnosed with either schizophrenia or bipolar disorder and matched controls. The TEC-M is an ecologically valid, clinician-rated observational test measure of spontaneous emotion regulation. We aimed to compare emotion regulation between risk groups and to investigate associations between emotion regulation and psychopathology and daily life functioning, and between emotion regulation and an acknowledged questionnaire-based dysregulation profile. RESULTS In this early developmental phase, we found no between group differences in emotion regulation. We found a significant but weak negative association between emotion regulation and both child psychopathology and the presence of a dysregulation profile on the Child Behavior Checklist and a weak positive association between emotion regulation and current level of functioning. CONCLUSIONS These findings contribute to the understanding of emotion regulation in familial high-risk children and further studies of emotion regulation in children at familial high risk of severe mental illness are warranted.
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Affiliation(s)
- Katrine Søborg Spang
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Julie Hagstrøm
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark
| | - Ditte Ellersgaard
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark.,Mental Health Services - Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Camilla Christiani
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Mental Health Services - Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Nicoline Hemager
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark.,Mental Health Services - Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Birgitte Klee Burton
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark
| | - Aja Neergaard Greve
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark.,Psychosis Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark
| | - Kirsten Rohr
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark
| | - Ditte Gantriis
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark.,Psychosis Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark
| | - Signe Vangkilde
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark.,Department of Psychology, Center for Visual Cognition, University of Copenhagen, Copenhagen, Denmark
| | - Ole Mors
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark.,Psychosis Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark
| | - Merete Nordentoft
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Mental Health Services - Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Carsten Obel
- Department of Public Health, University of Aarhus, Aarhus, Denmark
| | - Kerstin Jessica Plessen
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark.,Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Jens Richardt Møllegaard Jepsen
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark.,Mental Health Services - Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark.,Mental Health Services - Capital Region of Denmark, Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS) and Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental health Center Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Anne A E Thorup
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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16
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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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17
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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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18
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Gong J, Luo Y, He Y, Zhou L, Zhao L, Liu J. Epidemiology of psychotic-like experiences by subtypes and their relationship with emotional regulation and affective lability among Chinese college students. Schizophr Res 2022; 244:39-45. [PMID: 35569436 DOI: 10.1016/j.schres.2022.02.037] [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: 02/01/2022] [Accepted: 02/26/2022] [Indexed: 10/18/2022]
Abstract
Although psychotic-like experiences (PLEs) are transient and not pathognomonic for psychiatric disorders, they may increase the risk of concurrent and future psychiatric disorders. However, the prevalence of PLEs and the different effects of PLE subtypes on mood outcomes are still unclear. Thus, this study seeks to investigate the prevalence of PLE subtypes and explore their relationship with the use of specific emotion regulation strategies and the level of affective lability among college students. The history of PLEs, the level of affective lability, and the use of specific emotion regulation strategies were assessed via self-reported questionnaires, and 1905 college students and 1812 college students were included in separate analyses. This study found that 14.44% of college students reported ever experiencing any of the five PLEs, with males reporting more PLE symptoms and a higher number of PLEs than females. Different PLE subtypes had different effects on the use of specific emotion regulation strategies (cognitive reappraisal or suppression) and the level of affective lability and also showed gender differences. Cognitive reappraisal and suppression differently predicted affective lability in males and females, and cognitive reappraisal mediated the relationship between hearing voices in PLEs and affective lability in males. In conclusion, PLEs were common in Chinese college students and gender differences were revealed in the prevalence of PLE subtypes. PLEs were associated with the use of specific emotion regulation strategies and the level of affective lability. Cognitive reappraisal may be a promising target for intervention aimed at relieving the effect of PLEs in non-clinical individuals.
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Affiliation(s)
- Jingbo Gong
- Shanghai Changning Mental Health Center, Shanghai 200335, China; Department of Applied Psychology, Hunan university of Chinese medicine, Changsha, Hunan, China
| | - Yanhong Luo
- Department of Applied Psychology, Hunan university of Chinese medicine, Changsha, Hunan, China
| | - Yuqiong He
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Lihua Zhou
- College of Education Science, Hengyang Normal University, Hengyang, Hunan 421001, China
| | - Lishun Zhao
- Department of Applied Psychology, Hunan university of Chinese medicine, Changsha, Hunan, China
| | - Jianbo Liu
- Department of Child Psychiatry of Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen Institute of Mental Health, Shenzhen Key Laboratory of Mental Health, Shenzhen, China.
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19
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Zhan C, Mao Z, Zhao X, Shi J. Association between Parents’ Relationship, Emotion-Regulation Strategies, and Psychotic-like Experiences in Adolescents. CHILDREN 2022; 9:children9060815. [PMID: 35740752 PMCID: PMC9222062 DOI: 10.3390/children9060815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/06/2022] [Accepted: 05/26/2022] [Indexed: 12/03/2022]
Abstract
This study aimed to examine the association between the psychotic-like experiences (PLEs) and emotion-regulation (ER) strategies of adolescents and their parents’ relationship, and we hypothesized that the parents’ relationship moderates the link between ER strategies and PLEs. We recruited a total of 2708 first-year college students (1659 males and 1049 females) aged 15–20 years (mean = 17.9). Participants completed assessments of PLEs, their use of ER strategies, and reported their parents’ relationship as harmonious, conflicting, or divorced. Regression analyses indicated that the lower the use of the emotion-reappraisal strategy, the greater the use of the emotion-suppression strategy and that parental conflict or divorce predicted the number of PLEs endorsed and the level of distress from the PLEs. The parents’ relationship moderated the association between ER strategies and distress from PLEs. Among those who reported parental conflict or divorce, their lower use of the reappraisal strategy predicted their experiencing higher levels of distress from their PLEs. This study suggested the direct and interactive influence of the parents’ relationship and ER strategies on the presence of PLEs and PLE-related distress levels among adolescents, which may represent potential intervention targets.
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Affiliation(s)
- Chenyu Zhan
- Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China;
| | - Ziyu Mao
- Ruijin Hospital Luwan Branch, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China;
| | - Xudong Zhao
- Clinical Research Center for Mental Disorders, Chinese-German Institute of Mental Health, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai 200124, China
- Correspondence:
| | - Jingyu Shi
- Division of Medical Humanities & Behavioral Sciences, Tongji University School of Medicine, Shanghai 200331, China;
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20
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Riehle M, Pillny M, Lincoln TM. Expanding the positivity offset theory of anhedonia to the psychosis continuum. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:47. [PMID: 35853895 PMCID: PMC9261090 DOI: 10.1038/s41537-022-00251-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/22/2022] [Indexed: 06/15/2023]
Abstract
People with schizophrenia and negative symptoms show diminished net positive emotion in low-arousing contexts (diminished positivity offset) and co-activate positive and negative emotion more frequently (increased ambivalence). Here, we investigated whether diminished positivity offset and increased ambivalence covary with negative symptoms along the continuum of psychotic symptoms. We conducted an online-study in an ad-hoc community sample (N = 261). Participants self-reported on psychotic symptoms (negative symptoms, depression, positive symptoms, anhedonia) and rated positivity, negativity, and arousal elicited by pleasant, unpleasant, and neutral stimuli. The data were analyzed with multilevel linear models. Increasing levels of all assessed symptom areas showed significant associations with diminished positivity offset. Increased ambivalence was related only to positive symptoms. Our results show that the diminished positivity offset is associated with psychotic symptoms in a community sample, including, but not limited to, negative symptoms. Ecological validity and symptom specificity require further investigation.
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Affiliation(s)
- Marcel Riehle
- Clinical Psychology and Psychotherapy, Institute for Psychology, Universität Hamburg, Hamburg, Germany.
| | - Matthias Pillny
- Clinical Psychology and Psychotherapy, Institute for Psychology, Universität Hamburg, Hamburg, Germany
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute for Psychology, Universität Hamburg, Hamburg, Germany
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21
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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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22
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Anderson Z, Gupta T, Revelle W, Haase CM, Mittal VA. Alterations in Emotional Diversity Correspond With Increased Severity of Attenuated Positive and Negative Symptoms in the Clinical High-Risk Syndrome. Front Psychiatry 2021; 12:755027. [PMID: 35002795 PMCID: PMC8732994 DOI: 10.3389/fpsyt.2021.755027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 12/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Alterations in emotional functioning are a key feature of psychosis and are present in individuals with a clinical high-risk (CHR) syndrome. However, little is known about alterations in emotional diversity (i.e., the variety and relative abundance of emotions that humans experience) and clinical correlates in this population. Methods: Individuals meeting criteria for a CHR syndrome (N = 47) and matched healthy controls (HC) (N = 58) completed the modified Differential Emotions Scale (used to derive scores of total, positive, and negative emotional diversity) and clinical interviews (i.e., Structured Interview for Psychosis-Risk Syndromes). Results: Findings showed that the CHR group experienced lower levels of positive emotional diversity compared to HCs. Among the CHR individuals, lower levels of positive and higher levels of negative emotional diversity were associated with more severe attenuated positive and negative symptoms. Analyses controlled for mean levels of emotion and current antipsychotic medication use. Discussion: Results demonstrate that altered emotional diversity (in particular lower levels of positive and higher levels of negative emotional diversity) is a clinically relevant marker in CHR individuals, above and beyond alterations in mean levels of emotional experiences. Future studies may probe sources, downstream consequences, and potential modifiability of decreased emotional diversity in individuals at CHR.
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Affiliation(s)
- Zachary Anderson
- Department of Psychology, Northwestern University, Evanston, IL, United States
| | - Tina Gupta
- Department of Psychology, Northwestern University, Evanston, IL, United States
| | - William Revelle
- Department of Psychology, Northwestern University, Evanston, IL, United States
| | - Claudia M. Haase
- School of Education and Social Policy, Northwestern University, Evanston, IL, United States
| | - Vijay A. Mittal
- Department of Psychology, Northwestern University, Evanston, IL, United States
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23
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Brewer R, Murphy J, Bird G. Atypical interoception as a common risk factor for psychopathology: A review. Neurosci Biobehav Rev 2021; 130:470-508. [PMID: 34358578 PMCID: PMC8522807 DOI: 10.1016/j.neubiorev.2021.07.036] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 07/09/2021] [Accepted: 07/31/2021] [Indexed: 02/06/2023]
Abstract
The inadequacy of a categorial approach to mental health diagnosis is now well-recognised, with many authors, diagnostic manuals and funding bodies advocating a dimensional, trans-diagnostic approach to mental health research. Variance in interoception, the ability to perceive one's internal bodily state, is reported across diagnostic boundaries, and is associated with atypical functioning across symptom categories. Drawing on behavioural and neuroscientific evidence, we outline current research on the contribution of interoception to numerous cognitive and affective abilities (in both typical and clinical populations), and describe the interoceptive atypicalities seen in a range of psychiatric conditions. We discuss the role that interoception may play in the development and maintenance of psychopathology, as well as the ways in which interoception may differ across clinical presentations. A number of important areas for further research on the role of interoception in psychopathology are highlighted.
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Affiliation(s)
- Rebecca Brewer
- Department of Psychology, Royal Holloway, University of London, United Kingdom
| | - Jennifer Murphy
- Department of Psychology, Royal Holloway, University of London, United Kingdom.
| | - Geoffrey Bird
- Department of Experimental Psychology, University of Oxford, United Kingdom; Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
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24
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Bahlinger K, Lincoln TM, Clamor A. Are Acute Increases and Variability in Emotion Regulation Strategies Related to Negative Affect and Paranoid Thoughts in Daily Life? COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10253-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Background
Negative affect reliably predicts paranoid thoughts. Previous studies point to the importance of emotion regulation for paranoid thoughts but have not yet focused on effects of acute increases and variability in strategy use.
Methods
We conducted an experience-sampling study for one week in a subclinical sample. Acute increases in the intensity of strategy use from one measurement point until the next, between-strategy variability (i.e., standard deviation between all strategies at one measurement point), and within-strategy variability (i.e., standard deviation of each strategy over one day) were analyzed for effects on negative affect and paranoid thoughts.
Results
Multi-level-models indicated that acute increases in acceptance and reappraisal are associated with less negative affect. Acute increases in acceptance, but not in reappraisal, were related to less paranoid thoughts. In contrast, acute increases in rumination and suppression were associated with more negative affect and paranoid thoughts. Between- and within-strategy variability were no significant predictors.
Conclusions
Acute increases in the intensity of but not variability in emotion regulation strategies are related to negative affect and paranoid thoughts in daily life. Future studies are needed to examine whether improving emotion regulation leads to sustainable reductions in symptoms.
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25
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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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26
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Grattan RE, Karcher NR, Maguire AM, Hatch B, Barch DM, Niendam TA. Psychotic Like Experiences are Associated with Suicide Ideation and Behavior in 9 to 10 Year Old Children in the United States. Res Child Adolesc Psychopathol 2021; 49:255-265. [PMID: 33294964 PMCID: PMC8188961 DOI: 10.1007/s10802-020-00721-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2020] [Indexed: 11/26/2022]
Abstract
Those experiencing psychotic like experiences (PLEs) are at higher risk for suicide ideation and behavior. However, it is unclear if PLEs are related to suicide ideation and behavior in children, and whether other factors such as impulsivity or emotion dysregulation might moderate the relationship. We hypothesize that PLEs are associated with suicide ideation and behavior, with impulsivity and emotion dysregulation moderating this relationship, in middle childhood. History of PLEs, suicide ideation and behavior, depression, emotion dysregulation, and impulsivity were assessed for 10,624 children aged 9 to 10.9 years (47.8% female, 34.4% minority race, 20.0% Hispanic) as part of the Adolescent Brain Cognitive Development℠ study. Hypotheses about associations between variables were assessed using hierarchical linear modeling. PLEs were associated with suicide ideation and suicide behavior even when controlling for depression severity. Emotion dysregulation and impulsivity were also associated with suicide ideation and moderated the relationship between PLEs and suicide ideation. Variation in suicide ideation due to impulsivity and emotion dysregulation appears to be strongest when people are experiencing low levels to no PLEs. Only impulsivity and PLEs were associated with suicide behavior. Depression was associated with suicide ideation, but not suicide behavior. PLEs may be an important risk factor for suicide ideation and behavior in 9 to 10-year-old children, comparable to adult and adolescent populations. When considering prevention of suicidality, these data suggest that considering the relations between PLEs, impulsivity and emotion dysregulation may be important.
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Affiliation(s)
- Rebecca E Grattan
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, 4701 X St, Sacramento, CA, 95817, USA
| | - Nicole R Karcher
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Adrienne M Maguire
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, 4701 X St, Sacramento, CA, 95817, USA
| | - Burt Hatch
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, 4701 X St, Sacramento, CA, 95817, USA
| | - Deanna M Barch
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Tara A Niendam
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, 4701 X St, Sacramento, CA, 95817, USA.
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27
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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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28
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Bahlinger K, Lincoln TM, Krkovic K, Clamor A. Linking psychophysiological adaptation, emotion regulation, and subjective stress to the occurrence of paranoia in daily life. J Psychiatr Res 2020; 130:152-159. [PMID: 32823048 DOI: 10.1016/j.jpsychires.2020.07.021] [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] [Received: 04/17/2020] [Revised: 07/12/2020] [Accepted: 07/17/2020] [Indexed: 12/22/2022]
Abstract
As stress is relevant to the formation of paranoia, maladaptive behavioral and physiological stress regulation is discussed as a crucial indicator of vulnerability. This is supported by research linking psychosis to the tendency to make less use of functional and more use of dysfunctional emotion regulation strategies (ER) and with a lower vagally-mediated heart rate variability (HRV). However, it remains unclear whether ER serves as a mediator between resting-state HRV on the one hand and subjective stress levels and paranoia on the other and whether this is specific to paranoia as compared to depression. We used an experience sampling method during seven days to repeatedly assess the experience of stress, usage of ER strategies, paranoia und depression (9/day) in a sample with subclinical positive symptoms (N = 32). Resting-state HRV was measured during a 5min interval in the laboratory. Data was analyzed by multi-level models. Higher resting-state HRV was predictive of lower stress-levels and of using more functional ER strategies (reappraisal, acceptance) in daily life, but did not predict the use of dysfunctional strategies (rumination, suppression) or paranoia. The association between resting-state HRV and stress was mediated by the usage of functional ER. Less functional and more dysfunctional ER were linked to higher levels of stress, paranoia and depression. Our study highlights that deficits in ER represent a link between psychophysiological and phenomenological aspects of paranoia but also of depression. This encourages to further investigate transdiagnostic prevention and therapy programs aiming to improve ER and to increase HRV.
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Affiliation(s)
- Katrin Bahlinger
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement Sciences, Universität Hamburg, Germany.
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement Sciences, Universität Hamburg, Germany
| | - Katarina Krkovic
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement Sciences, Universität Hamburg, Germany
| | - Annika Clamor
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement Sciences, Universität Hamburg, Germany
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29
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Wang Y, Liao C, Shangguan C, Shang W, Zhang W. Individual differences in emotion differentiation modulate electrocortical dynamics of cognitive reappraisal. Psychophysiology 2020; 57:e13690. [DOI: 10.1111/psyp.13690] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 08/25/2020] [Accepted: 08/25/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Yali Wang
- Zhejiang University of Finance and Economics Hangzhou China
| | - Caizhi Liao
- College of Education Science Chengdu University Chengdu China
| | - Chenyu Shangguan
- Department of Psychology Education College Shanghai Normal University Shanghai China
| | - Wenjing Shang
- Department of Psychology Chengde Medical College Chengde China
| | - Wenhai Zhang
- Mental Health Center Yancheng Institute of Technology Yancheng China
- The Big Data Centre for Educational Neuroscience and AI Hengyang Normal University Hengyang China
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30
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DeRosse P, Barber AD. Overlapping Neurobiological Substrates for Early-Life Stress and Resilience to Psychosis. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 6:144-153. [PMID: 33097471 DOI: 10.1016/j.bpsc.2020.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
Early-life stress, such as childhood maltreatment, is a well-known etiological factor in psychopathology, including psychosis. Exposure to early-life stress disrupts the neurodevelopment of widespread brain systems, including key components of the hypothalamic-pituitary-adrenal axis stress response, such as the amygdala, hippocampus, and medial prefrontal cortex, as well as key components of the brain's reward system, such as the nucleus accumbens and orbitofrontal cortex. These disruptions have a considerable impact on the function of emotion and reward circuitry, which play a central role in the emergence and severity of psychosis. While this overlap may provide insight into the pathophysiology of psychosis, it also provides unique opportunities to elucidate neurobiological substrates that may promote resilience to psychosis. In this review, we discuss the hypothalamic-pituitary-adrenal axis stress response, discuss the disruption in the neurodevelopment of emotion and reward processing associated with early stress exposures, and examine how this circuitry may contribute to resilience to psychotic disorders.
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Affiliation(s)
- Pamela DeRosse
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; Center for Psychiatric Neuroscience, The Feinstein Institutes for Medical Research, Manhasset, New York; Division of Psychiatry Research, The Zucker Hillside Hospital, Division of Northwell Health, Glen Oaks, New York.
| | - Anita D Barber
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; Center for Psychiatric Neuroscience, The Feinstein Institutes for Medical Research, Manhasset, New York; Division of Psychiatry Research, The Zucker Hillside Hospital, Division of Northwell Health, Glen Oaks, New York
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31
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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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32
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Hoffman KW, Lee JJ, Corcoran CM, Kimhy D, Kranz TM, Malaspina D. Considering the Microbiome in Stress-Related and Neurodevelopmental Trajectories to Schizophrenia. Front Psychiatry 2020; 11:629. [PMID: 32719625 PMCID: PMC7350783 DOI: 10.3389/fpsyt.2020.00629] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/16/2020] [Indexed: 12/12/2022] Open
Abstract
Early life adversity and prenatal stress are consistently associated with an increased risk for schizophrenia, although the exact pathogenic mechanisms linking the exposures with the disease remain elusive. Our previous view of the HPA stress axis as an elegant but simple negative feedback loop, orchestrating adaptation to stressors among the hypothalamus, pituitary, and adrenal glands, needs to be updated. Research in the last two decades shows that important bidirectional signaling between the HPA axis and intestinal mucosa modulates brain function and neurochemistry, including effects on glucocorticoid hormones and brain-derived neurotrophic factor (BDNF). The intestinal microbiome in earliest life, which is seeded by the vaginal microbiome during delivery, programs the development of the HPA axis in a critical developmental window, determining stress sensitivity and HPA function as well as immune system development. The crosstalk between the HPA and the Microbiome Gut Brain Axis (MGBA) is particularly high in the hippocampus, the most consistently disrupted neural region in persons with schizophrenia. Animal models suggest that the MGBA remains influential on behavior and physiology across developmental stages, including the perinatal window, early childhood, adolescence, and young adulthood. Understanding the role of the microbiome on critical risk related stressors may enhance or transform of understanding of the origins of schizophrenia and offer new approaches to increase resilience against stress effects for preventing and treating schizophrenia.
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Affiliation(s)
- Kevin W. Hoffman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jakleen J. Lee
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Cheryl M. Corcoran
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- James J. Peters VA Medical Center, Mental Illness Research, Education and Clinical Centers (MIRECC), New York, NY, United States
| | - David Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- James J. Peters VA Medical Center, Mental Illness Research, Education and Clinical Centers (MIRECC), New York, NY, United States
| | - Thorsten M. Kranz
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt, Germany
| | - Dolores Malaspina
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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33
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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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Montag C, Brandt L, Lehmann A, De Millas W, Falkai P, Gaebel W, Hasan A, Hellmich M, Janssen B, Juckel G, Karow A, Klosterkötter J, Lambert M, Maier W, Müller H, Pützfeld V, Schneider F, Stützer H, Wobrock T, Vernaleken IB, Wagner M, Heinz A, Bechdolf A, Gallinat J. Cognitive and emotional empathy in individuals at clinical high risk of psychosis. Acta Psychiatr Scand 2020; 142:40-51. [PMID: 32339254 DOI: 10.1111/acps.13178] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Impairments of social cognition are considered core features of schizophrenia and are established predictors of social functioning. However, affective aspects of social cognition including empathy have far less been studied than its cognitive dimensions. The role of empathy in the development of schizophrenia remains largely elusive. METHODS Emotional and cognitive empathy were investigated in large sample of 120 individuals at Clinical High Risk of Psychosis (CHR-P) and compared with 50 patients with schizophrenia and 50 healthy controls. A behavioral empathy assessment, the Multifaceted Empathy Test, was implemented, and associations of empathy with cognition, social functioning, and symptoms were determined. RESULTS Our findings demonstrated significant reductions of emotional empathy in individuals at CHR-P, while cognitive empathy appeared intact. Only individuals with schizophrenia showed significantly reduced scores of cognitive empathy compared to healthy controls and individuals at CHR-P. Individuals at CHR-P were characterized by significantly lower scores of emotional empathy and unspecific arousal for both positive and negative affective valences compared to matched healthy controls and patients with schizophrenia. Results also indicated a correlation of lower scores of emotional empathy and arousal with higher scores of prodromal symptoms. CONCLUSION Findings suggest that the tendency to 'feel with' an interaction partner is reduced in individuals at CHR-P. Altered emotional reactivity may represent an additional, early vulnerability marker, even if cognitive mentalizing is grossly unimpaired in the prodromal stage. Different mechanisms might contribute to reductions of cognitive and emotional empathy in different stages of non-affective psychotic disorders and should be further explored.
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Affiliation(s)
- C Montag
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany
| | - L Brandt
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany
| | - A Lehmann
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany
| | - W De Millas
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Vivantes Wenckebach-Klinikum, Berlin, Germany
| | - P Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - W Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - A Hasan
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - M Hellmich
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Cologne, Cologne, Germany.,Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - B Janssen
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.,LVR-Klinik Langenfeld, Langenfeld, Germany
| | - G Juckel
- Department of Psychiatry, Psychotherapy, and Preventive Medicine, Ruhr University Bochum, Bochum, Germany
| | - A Karow
- Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - J Klosterkötter
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - M Lambert
- Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - W Maier
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,Department of Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Bonn, Germany.,DZNE, German Center for Neurodegenerative Diseases, Bonn, Germany
| | - H Müller
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - V Pützfeld
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - F Schneider
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.,Department of Psychiatry, Psychotherapy, and Psychosomatics, RWTH Aachen, Aachen, Germany
| | - H Stützer
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - T Wobrock
- Department of Psychiatry and Psychotherapy, Georg-August-University Goettingen, Goettingen, Germany.,Department of Psychiatry and Psychotherapy, County Hospitals Darmstadt-Dieburg, Groß-Umstadt, Germany
| | - I B Vernaleken
- Department of Psychiatry, Psychotherapy, and Psychosomatics, RWTH Aachen, Aachen, Germany
| | - M Wagner
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,Department of Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Bonn, Germany.,DZNE, German Center for Neurodegenerative Diseases, Bonn, Germany
| | - A Heinz
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany
| | - A Bechdolf
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Vivantes Klinikum am Urban and Vivantes Klinikum im Friedrichshain, Berlin, Germany.,Faculty of Medicine, University Hospital Cologne, Cologne, Germany.,ORYGEN, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - J Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Williams JHG, Huggins CF, Zupan B, Willis M, Van Rheenen TE, Sato W, Palermo R, Ortner C, Krippl M, Kret M, Dickson JM, Li CSR, Lowe L. A sensorimotor control framework for understanding emotional communication and regulation. Neurosci Biobehav Rev 2020; 112:503-518. [PMID: 32070695 PMCID: PMC7505116 DOI: 10.1016/j.neubiorev.2020.02.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 01/22/2020] [Accepted: 02/11/2020] [Indexed: 12/12/2022]
Abstract
Our research team was asked to consider the relationship of the neuroscience of sensorimotor control to the language of emotions and feelings. Actions are the principal means for the communication of emotions and feelings in both humans and other animals, and the allostatic mechanisms controlling action also apply to the regulation of emotional states by the self and others. We consider how motor control of hierarchically organised, feedback-based, goal-directed action has evolved in humans, within a context of consciousness, appraisal and cultural learning, to serve emotions and feelings. In our linguistic analysis, we found that many emotion and feelings words could be assigned to stages in the sensorimotor learning process, but the assignment was often arbitrary. The embodied nature of emotional communication means that action words are frequently used, but that the meanings or senses of the word depend on its contextual use, just as the relationship of an action to an emotion is also contextually dependent.
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Affiliation(s)
- Justin H G Williams
- University of Aberdeen, Institute of Medical Sciences, Foresterhill, AB25 2ZD, Scotland, United Kingdom.
| | - Charlotte F Huggins
- University of Aberdeen, Institute of Medical Sciences, Foresterhill, AB25 2ZD, Scotland, United Kingdom
| | - Barbra Zupan
- Central Queensland University, School of Health, Medical and Applied Sciences, Bruce Highway, Rockhampton, QLD 4702, Australia
| | - Megan Willis
- Australian Catholic University, School of Psychology, ARC Centre for Excellence in Cognition and its Disorders, Sydney, NSW 2060, Australia
| | - Tamsyn E Van Rheenen
- University of Melbourne, Melbourne Neuropsychiatry Centre, Department of Psychiatry, 161 Barry Street, Carlton, VIC 3053, Australia
| | - Wataru Sato
- Kyoto University, Kokoro Research Centre, 46 Yoshidashimoadachicho, Sakyo Ward, Kyoto, 606-8501, Japan
| | - Romina Palermo
- University of Western Australia, School of Psychological Science, Perth, WA, 6009, Australia
| | - Catherine Ortner
- Thompson Rivers University, Department of Psychology, 805 TRU Way, Kamloops, BC V2C 0C8, Canada
| | - Martin Krippl
- Otto von Guericke University Magdeburg, Faculty of Natural Sciences, Department of Psychology, Universitätsplatz 2, Magdeburg, 39106, Germany
| | - Mariska Kret
- Leiden University, Cognitive Psychology, Pieter de la Court, Waassenaarseweg 52, Leiden, 2333 AK, the Netherlands
| | - Joanne M Dickson
- Edith Cowan University, Psychology Department, School of Arts and Humanities, 270 Joondalup Dr, Joondalup, WA 6027, Australia
| | - Chiang-Shan R Li
- Yale University, Connecticut Mental Health Centre, S112, 34 Park Street, New Haven, CT 06519-1109, USA
| | - Leroy Lowe
- Neuroqualia, Room 229A, Forrester Hall, 36 Arthur Street, Truro, Nova Scotia, B2N 1X5, Canada
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36
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McLaughlin KA, Colich NL, Rodman AM, Weissman DG. Mechanisms linking childhood trauma exposure and psychopathology: a transdiagnostic model of risk and resilience. BMC Med 2020; 18:96. [PMID: 32238167 PMCID: PMC7110745 DOI: 10.1186/s12916-020-01561-6] [Citation(s) in RCA: 205] [Impact Index Per Article: 51.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 03/17/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Transdiagnostic processes confer risk for multiple types of psychopathology and explain the co-occurrence of different disorders. For this reason, transdiagnostic processes provide ideal targets for early intervention and treatment. Childhood trauma exposure is associated with elevated risk for virtually all commonly occurring forms of psychopathology. We articulate a transdiagnostic model of the developmental mechanisms that explain the strong links between childhood trauma and psychopathology as well as protective factors that promote resilience against multiple forms of psychopathology. MAIN BODY We present a model of transdiagnostic mechanisms spanning three broad domains: social information processing, emotional processing, and accelerated biological aging. Changes in social information processing that prioritize threat-related information-such as heightened perceptual sensitivity to threat, misclassification of negative and neutral emotions as anger, and attention biases towards threat-related cues-have been consistently observed in children who have experienced trauma. Patterns of emotional processing common in children exposed to trauma include elevated emotional reactivity to threat-related stimuli, low emotional awareness, and difficulties with emotional learning and emotion regulation. More recently, a pattern of accelerated aging across multiple biological metrics, including pubertal development and cellular aging, has been found in trauma-exposed children. Although these changes in social information processing, emotional responding, and the pace of biological aging reflect developmental adaptations that may promote safety and provide other benefits for children raised in dangerous environments, they have been consistently associated with the emergence of multiple forms of internalizing and externalizing psychopathology and explain the link between childhood trauma exposure and transdiagnostic psychopathology. Children with higher levels of social support, particularly from caregivers, are less likely to develop psychopathology following trauma exposure. Caregiver buffering of threat-related processing may be one mechanism explaining this protective effect. CONCLUSION Childhood trauma exposure is a powerful transdiagnostic risk factor associated with elevated risk for multiple forms of psychopathology across development. Changes in threat-related social and emotional processing and accelerated biological aging serve as transdiagnostic mechanisms linking childhood trauma with psychopathology. These transdiagnostic mechanisms represent critical targets for early interventions aimed at preventing the emergence of psychopathology in children who have experienced trauma.
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Affiliation(s)
- Katie A McLaughlin
- Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA, 02138, USA.
| | - Natalie L Colich
- Department of Psychology, University of Washington, Box 351525, Seattle, WA, 98195, USA
| | - Alexandra M Rodman
- Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA, 02138, USA
| | - David G Weissman
- Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA, 02138, USA
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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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38
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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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39
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Lawlor C, Hepworth C, Smallwood J, Carter B, Jolley S. Self-reported emotion regulation difficulties in people with psychosis compared with non-clinical controls: A systematic literature review. Clin Psychol Psychother 2020; 27:107-135. [PMID: 31661593 DOI: 10.1002/cpp.2408] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 01/10/2023]
Abstract
Emotions play a key role in the development and experience of psychosis, yet there are important gaps in our understanding of how individuals with psychosis understand and respond to their emotions. This systematic review investigated self-reported emotion regulation difficulties in individuals with psychosis compared with non-clinical controls. An electronic database search was conducted in Medline, PsychINFO, and Embase and supplemented by searches of reference lists and citations. Seventeen studies were included. A narrative synthesis was conducted because contextual diversity was present across the studies and outcomes. Individuals with psychosis reported greater difficulties in (i) emotional clarity (specifically with identifying, describing, and understanding their emotions), (ii) emotional acceptance, (iii) engaging in goal-directed behaviours when experiencing negative emotions, and (iv) willingness to experience emotional distress in the pursuit of meaningful activities in life. Evidence pertaining to other self-reported emotion regulation difficulties was less clear. Effect sizes were generally large in magnitude but there were few studies on some self-reported emotion regulation difficulties, and all studies were at moderate to high risk of bias. Further research is needed to clarify the nature of emotion regulation difficulties in individuals with psychosis to inform the provision of targeted clinical interventions.
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Affiliation(s)
- Caroline Lawlor
- North Lambeth Focused Support Team, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Claire Hepworth
- North Lambeth Focused Support Team, South London and Maudsley NHS Foundation Trust, London, UK
| | - Jane Smallwood
- North Lambeth Focused Support Team, South London and Maudsley NHS Foundation Trust, London, UK
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Suzanne Jolley
- North Lambeth Focused Support Team, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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40
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Ludwig L, Mehl S, Schlier B, Krkovic K, Lincoln TM. Awareness and rumination moderate the affective pathway to paranoia in daily life. Schizophr Res 2020; 216:161-167. [PMID: 31892492 DOI: 10.1016/j.schres.2019.12.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/03/2019] [Accepted: 12/15/2019] [Indexed: 12/27/2022]
Abstract
Numerous cross-sectional studies found psychosis to be associated with less awareness of emotions, a decreased use of adaptive (e.g. reappraisal) and an increased use of maladaptive emotion regulation (ER) strategies (e.g. suppression). In this study, we tested whether state levels of emotion awareness and momentary use of specific ER strategies moderate the link between negative affect at one timepoint (t-1) and paranoia at the next timepoint (t) in a six-day experience sampling study. Individuals with psychotic disorders (n = 71) reported on the presence of paranoia, negative affect, emotion awareness and the use of six ER strategies (reappraisal, acceptance, social sharing, distraction, suppression and rumination) ten times per day. Multilevel regression analysis revealed that higher awareness at t-1 reduced the association of negative affect at t-1 and paranoia at t, whereas rumination had an opposite, amplifying moderation effect. Our results provide novel insight into the conditions under which negative affect translates into delusional beliefs. The finding that emotion awareness and rumination have a relevant role corresponds with current psychological conceptualisations of psychosis and with the attempt to treat delusions by focusing on reducing ruminative thoughts. To investigate the causal effect, treatment trials with a focus on enhancing these components of emotion regulation are needed.
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Affiliation(s)
- Lea Ludwig
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, 20146 Hamburg, Germany.
| | - Stephanie Mehl
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Marburg, 35039 Marburg, Germany; Faculty of Health and Social Work, Frankfurt University of Applied Sciences, 60318 Frankfurt am Main, Germany
| | - Björn Schlier
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, 20146 Hamburg, Germany
| | - Katarina Krkovic
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, 20146 Hamburg, Germany
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, 20146 Hamburg, Germany
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41
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Vakhrusheva J, Khan S, Chang R, Hansen M, Ayanruoh L, Gross J, Kimhy D. Lexical analysis of emotional responses to "real-world" experiences in individuals with schizophrenia. Schizophr Res 2020; 216:272-278. [PMID: 31839556 PMCID: PMC7239730 DOI: 10.1016/j.schres.2019.11.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 08/30/2019] [Accepted: 11/24/2019] [Indexed: 01/22/2023]
Abstract
Abnormalities in emotion perception, expression, and experience are considered a core component of schizophrenia. Previous laboratory studies have demonstrated that while individuals with schizophrenia report levels of positive emotions comparable to healthy individuals in response to positive stimuli, they also report co-occurring negative emotions in response to such stimuli. However, it is unknown whether this response pattern extends to "real world" naturalistic environments. To examine this question, we employed an experience sampling method (ESM) approach using mobile electronic devices to collect information up to 10 times/day over a two-day period from 53 individuals with schizophrenia and 19 non-clinical controls. As part of each experience sample, participants completed brief open-ended responses and answered questions about their emotional responses to three recent events (neutral, positive, and negative). Additionally, participants completed diagnostic and clinical measures. Lexical analyses were used to analyze ESM-based word production and characterize emotion word use. Compared to non-clinical controls, individuals with schizophrenia reported similar levels of positive emotion, but significantly higher negative emotion, which was associated with increased negative symptoms. The schizophrenia group used more anxiety words in response to negative and neutral events, and more anger words in response to positive events. Increased use of anger words was linked with elevations in positive symptoms as well as symptoms of depression, while use of sadness words was linked with anhedonia. Our findings support the co-activation of negative emotion hypothesis documented in laboratory settings and provide evidence of its ecological validity. Implications for functioning and future directions are discussed.
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Affiliation(s)
- J. Vakhrusheva
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY
| | - S. Khan
- New York State Psychiatric Institute, New York, NY
| | - R. Chang
- New York State Psychiatric Institute, New York, NY
| | - M. Hansen
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY
| | - L. Ayanruoh
- New York State Psychiatric Institute, New York, NY
| | - J.J. Gross
- Department of Psychiatry & Behavioral Science, Stanford University, Stanford, CA
| | - D. Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
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42
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Gruber J, Villanueva C, Burr E, Purcell JR, Karoly H. Understanding and Taking Stock of Positive Emotion Disturbance. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2020; 14:e12515. [PMID: 37636238 PMCID: PMC10456988 DOI: 10.1111/spc3.12515] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The prevailing view on positive emotions is that they correlate with and confer psychological health benefits for the individual, including improved social, physical and cognitive functioning. Yet an emerging wave of scientific work suggests that positive emotions are also related to a range of suboptimal psychological health outcomes, especially when the intensity, duration, or context do not optimize the individual's goals or meet current environmental demands. This paper provides an overview of the 'other side' of positive emotion, by describing and reviewing evidence supporting the emerging field of Positive Emotion Disturbance (PED). We review relevant emotion processes and key themes of PED and apply this framework to example emotional disorders, and discuss implications for psychological change and future research agendas.
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Affiliation(s)
- June Gruber
- Department of Psychology and Neuroscience, University of Colorado Boulder
| | - Cynthia Villanueva
- Department of Psychology and Neuroscience, University of Colorado Boulder
| | - Emily Burr
- Department of Psychology and Neuroscience, University of Colorado Boulder
| | - John R. Purcell
- Department of Psychological & Brain Sciences, Indiana University
| | - Hollis Karoly
- Department of Psychology and Neuroscience, University of Colorado Boulder
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43
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Ludwig L, Werner D, Lincoln TM. The relevance of cognitive emotion regulation to psychotic symptoms – A systematic review and meta-analysis. Clin Psychol Rev 2019; 72:101746. [DOI: 10.1016/j.cpr.2019.101746] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 04/26/2019] [Accepted: 06/11/2019] [Indexed: 12/24/2022]
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44
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Devoe DJ, Farris MS, Townes P, Addington J. Interventions and social functioning in youth at risk of psychosis: A systematic review and meta-analysis. Early Interv Psychiatry 2019; 13:169-180. [PMID: 29938910 DOI: 10.1111/eip.12689] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/28/2018] [Accepted: 05/16/2018] [Indexed: 12/17/2022]
Abstract
AIM Youth at clinical high risk (CHR) for psychosis often exhibit difficulties in social functioning and poorer social functioning may be predictive of transition to a psychotic disorder. Therefore, the primary objective of this systematic review was to summarize the impact of all interventions on social functioning in CHR samples. METHOD Electronic databases PsycINFO, CINAHL, Embase, EBM, and MEDLINE were searched from 1951 to June 2017. Studies were selected if they included any intervention that reported changes in social functioning in youth at CHR. Data were evaluated using random effects pairwise meta-analyses, stratified by time, and reported as the standardized mean difference (SMD). RESULTS Nineteen studies met our inclusion criteria, including a total of 1513 CHR participants. The mean age was 20.5 years and 47% were male. Cognitive behavioural therapy (4 studies) did not significantly improve social functioning at 6 months (SMD = 0.06; 95% confidence interval [CI] = -0.35, 0.46), 12 months (SMD = -0.15; 95% CI = -0.38, 0.08) and 18 months (SMD = 0.20; 95% CI = -0.10, 0.50). Omega-3 (2 studies) did not significantly improve social functioning at 6 months (SMD = 0.01; 95% CI = -0.21, 0.24) and 12 months (SMD = -0.08; 95% CI = -0.33, 0.17). Lastly, cognitive remediation (3 studies) did not significantly improve social functioning at 2- to 3-month follow-up (SMD = 0.13, 95% CI = -0.18, 0.43). CONCLUSIONS This systematic review and meta-analysis demonstrated that no treatment significantly improved social functioning in youth at CHR. Future randomized control trials are required that are designed to target and improve social functioning in youth at CHR for psychosis.
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Affiliation(s)
- Daniel J Devoe
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Megan S Farris
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Parker Townes
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
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Ospina LH, Shanahan M, Perez-Rodriguez MM, Chan CC, Clari R, Burdick KE. Alexithymia predicts poorer social and everyday functioning in schizophrenia and bipolar disorder. Psychiatry Res 2019; 273:218-226. [PMID: 30658205 PMCID: PMC6561815 DOI: 10.1016/j.psychres.2019.01.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 12/28/2022]
Abstract
Alexithymia, or the inability to identify and describe one's emotions, is significantly higher in bipolar disorder (BD) and schizophrenia (SZ), compared to healthy controls (HC). Alexithymia has also been observed to predict psychosocial functioning in SZ. We investigated whether alexithymia predicted social and everyday functioning in BD, as well as transdiagnostically in HC, BD, and SZ patients. 56 BD, 45 SZ, and 50 HC were administered and compared on tests measuring neurocognition, social cognition, functioning and alexithymia. We conducted linear regressions assessing whether alexithymia predicted functional outcomes in BD. Next, we conducted hierarchical stepwise linear regressions investigating the predictive ability of neurocognition, social cognition and alexithymia on everyday and social functioning in our overall sample. BD and SZ patients were comparable on most demographics and demonstrated higher alexithymia compared to HCs. In BD, alexithymia predicted social functioning only. In the overall sample, difficulty identifying and describing feelings predicted everyday functioning; difficulty describing feelings predicted social functioning. Results suggest that aspects of alexithymia significantly predict functioning among these psychiatric groups, above and beyond the contributions of previously identified factors such as neurocognition and social cognition. Results may aid in developing proper interventions aimed at improving patients' ability to articulate their feelings.
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Affiliation(s)
- L H Ospina
- Icahn School of Medicine at Mount Sinai, Departments of Psychiatry and Neuroscience, New York NY, United States.
| | - M Shanahan
- Icahn School of Medicine at Mount Sinai, Departments of Psychiatry and Neuroscience, New York NY, United States; Brigham and Women's Hospital, Department of Psychiatry, Boston MA, United States
| | - M M Perez-Rodriguez
- Icahn School of Medicine at Mount Sinai, Departments of Psychiatry and Neuroscience, New York NY, United States
| | - C C Chan
- Icahn School of Medicine at Mount Sinai, Departments of Psychiatry and Neuroscience, New York NY, United States
| | - R Clari
- Icahn School of Medicine at Mount Sinai, Departments of Psychiatry and Neuroscience, New York NY, United States
| | - K E Burdick
- Icahn School of Medicine at Mount Sinai, Departments of Psychiatry and Neuroscience, New York NY, United States; Brigham and Women's Hospital, Department of Psychiatry, Boston MA, United States; James J. Peters VA Medical Center, Bronx NY, United States; Harvard Medical School, Department of Psychiatry, Boston, MA, United States
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Gawęda Ł, Krężołek M. Cognitive mechanisms of alexithymia in schizophrenia: Investigating the role of basic neurocognitive functioning and cognitive biases. Psychiatry Res 2019; 271:573-580. [PMID: 30554105 DOI: 10.1016/j.psychres.2018.12.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 11/20/2018] [Accepted: 12/03/2018] [Indexed: 02/08/2023]
Abstract
Alexithymia is an important but poorly understood emotional deficit in schizophrenia. We aimed at investigating the role of basic cognitive functions, cognitive biases, and symptom severity in alexithymia among patients with schizophrenia. Sixty patients (31 females) with schizophrenia were assessed with standardized clinical interviews for symptom severity. Cognitive functioning was assessed with neuropsychological tests. A self-report scale (Davos Assessment of Cognitive Biases, DACOBS), as well as two experimental tasks assessing jumping to conclusions (the Fish task) and source monitoring (Action memory task), were used to investigate cognitive biases. Alexithymia was assessed with the Toronto Alexithymia Scale (TAS-20). Alexithymia was related to the severity of hallucinations but not delusions. Patients with a lifetime history of more psychotic symptoms had higher alexithymia. Alexithymia has broad relationships with different cognitive biases, especially in the self-reported measure. These relationships were not affected by neurocognition and symtpoms severity. In particular, difficulties in identification of feelings were related to various cognitive biases. Dysfunctional information processing can thus be considered as potential psychological correlates of alexithymia. The theoretical and clinical implications of our findings are discussed.
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Affiliation(s)
- Łukasz Gawęda
- II Department of Psychiatry, Medical University of Warsaw, Kondratowicza 8, 03-242 Warsaw, Poland.
| | - Martyna Krężołek
- II Department of Psychiatry, Medical University of Warsaw, Kondratowicza 8, 03-242 Warsaw, Poland
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Visser KF, Esfahlani FZ, Sayama H, Strauss GP. An ecological momentary assessment evaluation of emotion regulation abnormalities in schizophrenia. Psychol Med 2018; 48:2337-2345. [PMID: 29361997 DOI: 10.1017/s0033291717003865] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
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.
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Affiliation(s)
| | | | - Hiroki Sayama
- Department of Systems Science and Industrial Engineering,Binghamton University,NY,USA
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Abstract
Individuals with psychotic symptoms often report low global self-esteem (GSE). However, it remains unclear whether the low GSE is linked to the presence of psychotic symptoms or it is present before the onset of psychosis. In addition, the specific subdomains of GSE in these populations are unknown. To address this question, we conducted a cross-sectional study comparing global and SE elements among individuals at clinical high risk for psychosis (CHR; n = 36), individuals with schizophrenia (SCZ; n = 43), and healthy controls (HCs; n = 40). We then examined among CHR individuals the association between GSE, subdomains, and symptoms. CHR individuals displayed significantly lower GSE compared to HCs, at a level comparable with those for individuals with SCZ. The low GSE was driven primarily by self-perceptions of work and interpersonal relationships abilities. Lower GSE was associated with overall negative and disorganized symptoms severity, but not positive ones. The authors discuss the implications of the findings to intervention development.
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Lincoln TM, Sundag J, Schlier B, Karow A. The Relevance of Emotion Regulation in Explaining Why Social Exclusion Triggers Paranoia in Individuals at Clinical High Risk of Psychosis. Schizophr Bull 2018; 44:757-767. [PMID: 29878274 PMCID: PMC6007363 DOI: 10.1093/schbul/sbx135] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Vulnerability-stress models postulate that social stress triggers psychotic episodes in vulnerable individuals. However, experimental evidence for the proposed causal pathway is scarce and the translating mechanisms are insufficiently understood. The study assessed the impact of social exclusion on paranoid beliefs in a quasi-experimental design and investigated the role of emotion regulation (ER) as a vulnerability indicator and emotional responses as a putative translating mechanism. METHODS Participants fulfilling criteria for clinical high risk of psychosis (CHR, n = 25), controls with anxiety disorders (AC, n = 40), and healthy controls (HC, n = 40) were assessed for dysfunctional (eg, rumination, catastrophizing, blaming) and functional ER-strategies (eg, reappraising, accepting, refocusing). They were then exposed to social exclusion during a virtual ball game (Cyberball) and assessed for changes in self-reported emotions and paranoid beliefs. RESULTS The CHR sample showed a significantly stronger increase in paranoid beliefs from before to after the social exclusion than both control groups. This was accounted for by lower levels of functional and higher levels of dysfunctional ER (compared to HC) and by a stronger increase in self-reported negative emotion in the CHR group (compared to AC and HC). CONCLUSIONS The results confirm the role of negative emotion on the pathway from social stressors to psychotic symptoms and indicate that both the use of dysfunctional ER strategies and difficulties in employing functional strategies add to explaining why people at risk of psychosis respond to a social stressor with increased paranoia.
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Affiliation(s)
- Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Universität Hamburg, Hamburg, Germany
- To whom correspondence should be addressed; tel: 0049-40-428385360, fax: 0049-40-428386170, e-mail:
| | - Johanna Sundag
- Clinical Psychology and Psychotherapy, Institute of Psychology, Universität Hamburg, Hamburg, Germany
| | - Björn Schlier
- Clinical Psychology and Psychotherapy, Institute of Psychology, Universität Hamburg, Hamburg, Germany
| | - Anne Karow
- Department for Psychiatry and Psychotherapy, Psychosis Centre, Centre for Psychosocial Medicine, Universitätsklinik Hamburg-Eppendorf, Hamburg, Germany
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Tarbox-Berry SI, Perkins DO, Woods SW, Addington J. Premorbid social adjustment and association with attenuated psychotic symptoms in clinical high-risk and help-seeking youth. Psychol Med 2018; 48:983-997. [PMID: 28874223 DOI: 10.1017/s0033291717002343] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Attenuated positive symptom syndrome (APSS), characterized by 'putatively prodromal' attenuated psychotic-like pathology, indicates increased risk for psychosis. Poor premorbid social adjustment predicts severity of APSS symptoms and predicts subsequent psychosis in APSS-diagnosed individuals, suggesting application for improving detection of 'true' prodromal youth who will transition to psychosis. However, these predictive associations have not been tested in controls and therefore may be independent of the APSS diagnosis, negating utility for improving prediction in APSS-diagnosed individuals. METHOD Association between premorbid social maladjustment and severity of positive, negative, disorganized, and general APSS symptoms was tested in 156 individuals diagnosed with APSS and 76 help-seeking (non-APSS) controls enrolled in the Enhancing the Prospective Prediction of Psychosis (PREDICT) study using prediction analysis. RESULTS Premorbid social maladjustment was associated with social anhedonia, reduced expression of emotion, restricted ideational richness, and deficits in occupational functioning, independent of the APSS diagnosis. Associations between social maladjustment and suspiciousness, unusual thought content, avolition, dysphoric mood, and impaired tolerance to normal stress were uniquely present in participants meeting APSS criteria. Social maladjustment was associated with odd behavior/appearance and diminished experience of emotions and self only in participants who did not meet APSS criteria. CONCLUSIONS Predictive associations between poor premorbid social adjustment and attenuated psychotic-like pathology were identified, a subset of which were indicative of high risk for psychosis. This study offers a method for improving risk identification while ruling out low-risk individuals.
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Affiliation(s)
- S I Tarbox-Berry
- Department of Psychiatry,Yale University School of Medicine,New Haven,Connecticut,USA
| | - D O Perkins
- Department of Psychiatry,University of North Carolina at Chapel Hill,Chapel Hill,North Carolina,USA
| | - S W Woods
- Department of Psychiatry,Yale University School of Medicine,New Haven,Connecticut,USA
| | - J Addington
- Department of Psychiatry,University of Calgary,Calgary,Alberta,Canada
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