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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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2
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Phalen P, Kimhy D, Jobes D, Bennett M. Emotional distress and dysregulation as treatment targets to reduce suicide in psychosis: a scoping review. Eur Arch Psychiatry Clin Neurosci 2024; 274:955-961. [PMID: 37597022 DOI: 10.1007/s00406-023-01675-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/08/2023] [Indexed: 08/21/2023]
Abstract
There is a pressing need for effective treatments that address the high rate of suicide observed among people with psychosis. In this scoping review we highlight two suicidogenic treatment targets that have been relatively neglected in people with psychotic disorders: emotional distress and emotion dysregulation. We review the research on these constructs in psychosis and their relationship to suicide in this population, and then make clinical recommendations based on research findings. Emotional distress and emotional dysregulation may be promising treatment targets for suicide among people with psychosis.
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Affiliation(s)
- Peter Phalen
- Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland School of Medicine, 737 West Lombard Street, Baltimore, MD, USA.
| | - David Kimhy
- Department of Psychiatry, Icahn School of Medicine, New York, NY, USA
- Education and Clinical Center, James J. Peters VA Medical Center, Mental Illness Research, New York, NY, USA
| | - David Jobes
- Department of Psychology, The Catholic University of America, Washington, DC, USA
| | - Melanie Bennett
- Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland School of Medicine, 737 West Lombard Street, Baltimore, MD, USA
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Lho SK, Kim T, Moon SY, Kim M, Kwon JS. Alteration in left frontoparietal connectivity correlates with impaired cognitive reappraisal in early psychosis. Schizophr Res 2024; 267:130-137. [PMID: 38531160 DOI: 10.1016/j.schres.2024.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 01/08/2024] [Accepted: 03/19/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Impaired cognitive reappraisal is a notable symptom of early psychosis, but its neurobiological basis remains underexplored. We aimed to identify the underlying neurobiological mechanism of this impairment by using resting-state functional connectivity (FC) analyses focused on brain regions related to cognitive reappraisal. METHODS Resting-state functional magnetic resonance images were collected from 36 first-episode psychosis (FEP) patients, 32 clinical high-risk (CHR) individuals, and 48 healthy controls (HCs). Whole-brain FC maps using seed regions associated with cognitive reappraisal were generated and compared across the FEP, CHR and HC groups. We assessed the correlation between resting-state FC, reappraisal success ratio, positive symptom severity and social functioning controlling for covariates. RESULTS FEP patients showed higher FC between the left superior parietal lobe and left inferior frontal gyrus than HCs. Higher FC between the left superior parietal lobe and left inferior frontal gyrus negatively correlated with the reappraisal success ratio in the FEP group after controlling for covariates. Lower FC correlated with lower positive symptom severity and improved global functioning in the FEP group. CONCLUSIONS Alteration in left frontoparietal connectivity reflects impaired cognitive reappraisal in early psychosis, and such alteration correlates with increased positive symptoms and decreased global functioning. These findings offer a potential path for interventions targeting newly emerging symptoms in the early stages of psychosis.
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Affiliation(s)
- Silvia Kyungjin Lho
- Department of Psychiatry, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea; Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Taekwan Kim
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Sun-Young Moon
- Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea; Department of Public Health Service, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Minah Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Jun Soo Kwon
- Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea; Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
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4
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Bell IH, Eisner E, Allan S, Cartner S, Torous J, Bucci S, Thomas N. Methodological Characteristics and Feasibility of Ecological Momentary Assessment Studies in Psychosis: a Systematic Review and Meta-Analysis. Schizophr Bull 2024; 50:238-265. [PMID: 37606276 PMCID: PMC10919779 DOI: 10.1093/schbul/sbad127] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
BACKGROUND Ecological momentary assessment (EMA) involves completing multiple surveys over time in daily life, capturing in-the-moment experiences in real-world contexts. EMA use in psychosis studies has surged over several decades. To critically examine EMA use in psychosis research and assist future researchers in designing new EMA studies, this systematic review aimed to summarize the methodological approaches used for positive symptoms in psychosis populations and evaluate feasibility with a focus on completion rates. METHODS A systematic review of PubMed, PsycINFO, MEDLINE, Web of Science, EBSCOhost, and Embase databases using search terms related to EMA and psychosis was conducted. Excluding duplicate samples, a meta-analysis was conducted of EMA survey completion rates and meta-regression to examine predictors of completion. RESULTS Sixty-eight studies were included in the review. Characteristics and reporting of EMA methodologies were variable across studies. The meta-mean EMA survey completion computed from the 39 unique studies that reported a mean completion rate was 67.15% (95% CI = 62.3, 71.9), with an average of 86.25% of the sample meeting a one-third EMA completion criterion. No significant predictors of completion were found in the meta-regression. A variety of EMA items were used to measure psychotic experiences, of which few were validated. CONCLUSIONS EMA methods have been widely applied in psychosis studies using a range of protocols. Completion rates are high, providing clear evidence of feasibility in psychosis populations. Recommendations for reporting in future studies are provided.
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Affiliation(s)
- Imogen H Bell
- Orygen The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Emily Eisner
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, Zochonis Building, University of Manchester, Manchester, UK
- Greater Manchester Mental Health Foundation NHS Trust, Manchester, UK
| | | | - Sharla Cartner
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, Zochonis Building, University of Manchester, Manchester, UK
- Greater Manchester Mental Health Foundation NHS Trust, Manchester, UK
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
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Beals K, Torregrossa LJ, Smith R, Lane RD, Sheffield JM. Impaired emotional awareness is associated with childhood maltreatment exposure and positive symptoms in schizophrenia. Front Psychiatry 2024; 14:1325617. [PMID: 38283891 PMCID: PMC10811959 DOI: 10.3389/fpsyt.2023.1325617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/14/2023] [Indexed: 01/30/2024] Open
Abstract
Objectives Evidence suggests that emotional awareness-the ability to identify and label emotions-may be impaired in schizophrenia and related to positive symptom severity. Exposure to childhood maltreatment is a risk factor for both low emotional awareness and positive symptoms. Methods The current investigation examines associations between a performance-based measure of emotional awareness, positive symptom severity, and childhood maltreatment exposure in 44 individuals with a schizophrenia-spectrum disorder and 48 healthy comparison participants using the electronic Levels of Emotional Awareness Scale (eLEAS), Positive and Negative Syndrome Scale (PANSS) and Childhood Trauma Questionnaire (CTQ). Results Patients demonstrated significant deficits in emotional awareness overall, which was true for both self and others. In patients, lower emotional awareness was significantly associated with more severe positive symptoms. Emotional awareness was significantly impaired in patients with schizophrenia with self-reported maltreatment exposure, relative to other groups. Severity of maltreatment was not significantly associated with emotional awareness or positive symptoms when looking continuously, and there was no significant indirect effect. Conclusion These data suggest that emotional awareness impairments observed in schizophrenia may be exacerbated by exposure to childhood maltreatment, possibly putting individuals at greater risk for experiencing positive symptoms of psychosis.
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Affiliation(s)
- Kendall Beals
- Sheffield Lab, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
- Social Cognition and Recovery in Schizophrenia Lab, Department of Psychology, The University of Southern Mississippi, Hattiesburg, MS, United States
| | - Lénie J. Torregrossa
- Sheffield Lab, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Ryan Smith
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Richard David Lane
- Department of Psychiatry, University of Arizona, Tucson, AZ, United States
| | - Julia M. Sheffield
- Sheffield Lab, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
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Panayiotou G, Artemi TF, Theodorou M, Theodorou C, Neophytou K. Not “just for fun”: Gambling, substance use, and the transdiagnostic role of emotion regulation. COGENT PSYCHOLOGY 2023. [DOI: 10.1080/23311908.2023.2183677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Affiliation(s)
- Georgia Panayiotou
- Department of Psychology and Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus
| | - Tonia-Flery Artemi
- Department of Psychology and Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus
| | - Marios Theodorou
- Department of Psychology and Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus
| | - Christiana Theodorou
- Department of Psychology and Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus
| | - Klavdia Neophytou
- Department of Psychology and Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus
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7
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Raugh IM, Bartolomeo LA, Zhang L, James SH, Strauss GP. Deconstructing emotion regulation in schizophrenia: The nature of abnormalities at the selection and implementation stages. JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE 2023; 132:908-920. [PMID: 37668572 PMCID: PMC10592206 DOI: 10.1037/abn0000852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
Difficulties with emotion regulation are observed across psychiatric diagnoses, including psychotic disorders. Past studies using trait self-report indicate that people with schizophrenia (SZ) are less likely to use adaptive emotion regulation strategies and more likely to use maladaptive emotion regulation strategies than controls (CN). However, more recent evidence using ecological momentary assessment (EMA) indicates that regulation effectiveness and adaptiveness may vary across strategies. The present study aimed to systematically understand abnormalities in state-level emotion regulation strategy selection, effectiveness, and adaptiveness in SZ compared to CN using EMA. Participants (n = 50 SZ; n = 53 CN) completed 6 days of EMA surveys assessing emotional experience, emotion regulation, and symptoms. Results indicated that SZ selected interpersonal emotion regulation and avoidance more often than CN, while both groups selected reappraisal and distraction more often than avoidance and suppression. Overall, strategies were effective at reducing negative emotion and adaptive for reducing delusions over time. Reappraisal, avoidance, and suppression all significantly down-regulated delusions over time. Although some selection abnormalities were present in terms of rate of selection and effort exertion, people with SZ select strategies which are effective and adaptive in the short term. The present results have implications for how cognitive therapy for psychosis may target delusions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Ian M Raugh
- Department of Psychology, University of Georgia
| | | | - Luyu Zhang
- Department of Psychology, University of Georgia
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8
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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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9
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Pishdadian S, Martins F, Milanovic M, Doell FK, Kidd SA, Grossman MJ. Emotion regulation relates to clinical characteristics and quality of life but not daily functioning in psychosis spectrum outpatients. J Psychiatr Res 2023; 161:289-297. [PMID: 36947960 DOI: 10.1016/j.jpsychires.2023.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
Difficulties in emotion regulation (ER) can negatively impact the clinical course and outcomes of a range of psychiatric conditions, including psychosis spectrum disorders. Individuals with psychosis may exhibit poorer ER abilities, which have been associated with increased severity and distress of psychotic symptoms. A paucity of research has investigated the clinical correlates of ER in psychosis and the influence of these difficulties on indices of recovery, such as daily functioning and quality of life. In the present study, 59 outpatients presenting for Cognitive Behaviour Therapy for psychosis (CBTp) in a large psychiatric hospital completed an intake assessment of clinician-rated and self-reported measures prior to treatment. Poor ER abilities were positively correlated with positive symptoms (overall and delusions), social anxiety, depression, and self-reflectiveness and negatively correlated with quality of life and personal recovery. Multiple regression analyses showed ER was a significant predictor of quality of life but not daily functioning, which was predicted most by cognition and psychiatric symptoms. Overall, findings support the clinical utility of assessing emotion dysregulation in psychosis and provide a more nuanced understanding of how such challenges differentially influence recovery in psychosis, which can further inform treatment planning and intervention.
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Affiliation(s)
- Sara Pishdadian
- Complex Care and Recovery Program, 1051 Queen Street West, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H3, Canada; Department of Psychology, 4700 Keele Street, York University, Toronto, ON, M3J 1P3, Canada
| | - Felicia Martins
- Complex Care and Recovery Program, 1051 Queen Street West, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H3, Canada; Department of Psychology, 1265, Military Trail, University of Toronto Scarborough, Toronto, ON, M1C 1A4, Canada
| | - Melissa Milanovic
- Complex Care and Recovery Program, 1051 Queen Street West, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H3, Canada
| | - Faye K Doell
- Complex Care and Recovery Program, 1051 Queen Street West, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H3, Canada
| | - Sean A Kidd
- Complex Care and Recovery Program, 1051 Queen Street West, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H3, Canada
| | - Michael J Grossman
- Complex Care and Recovery Program, 1051 Queen Street West, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H3, Canada.
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Igra L, Shilon S, Kivity Y, Atzil-Slonim D, Lavi-Rotenberg A, Hasson-Ohayon I. Examining the associations between difficulties in emotion regulation and symptomatic outcome measures among individuals with different mental disorders. Front Psychol 2023; 14:944457. [PMID: 36998365 PMCID: PMC10043222 DOI: 10.3389/fpsyg.2023.944457] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 02/20/2023] [Indexed: 03/17/2023] Open
Abstract
BackgroundDifficulties in emotion regulation (ER) abilities have been found to play a central role in different psychiatric disorders. However, researchers rarely compare ER across different diagnostic groups. In the current study, we examined ER and its relation to functional and symptomatic outcome among three distinct diagnostic groups: people with schizophrenia (SCZ), people with emotional disorders (EDs; i.e., depression and/or anxiety), and individuals without any psychiatric diagnosis (controls).MethodsParticipants in this study comprised 108 adults who requested psychotherapy at a community clinic in the year 2015 and between 2017 and 2019. Clients were interviewed and filled out questionnaires measuring depression, distress, and difficulties in ER abilities.ResultsResults showed that individuals with psychiatric diagnoses reported higher levels of difficulties in ER abilities than did controls. Moreover, there were very few differences in levels of ER difficulty between SCZ and EDs. Further, the associations between maladaptive ER and psychological outcomes were significant in each diagnostic group, and especially for SCZ.ConclusionOur study indicates that difficulties in ER abilities partially have a transdiagnostic nature, and that these difficulties are associated with psychological outcomes among both clinical populations and controls. There were very few differences in levels of ER ability difficulties between SCZ and EDs, suggesting that the two groups share difficulties in relating and responding to emotional distress. The associations between difficulties in ER abilities and outcome were more robust and stronger among SCZ than the other groups, highlighting the potential contribution of targeting ER abilities in the treatment of schizophrenia.
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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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12
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Mavragani A, Lecomte T, Potvin S, Riopel G, Vézina C, Villeneuve M, Abdel-Baki A, Khazaal Y. A Mobile Health App (ChillTime) Promoting Emotion Regulation in Dual Disorders: Acceptability and Feasibility Pilot Study. JMIR Form Res 2023; 7:e37293. [PMID: 36705963 PMCID: PMC9919461 DOI: 10.2196/37293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 12/14/2022] [Accepted: 12/20/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND A growing number of studies highlight the importance of emotion regulation in the treatment and recovery of individuals with psychosis and concomitant disorders such as substance use disorder (SUD), for whom access to integrated dual-disorder treatments is particularly difficult. In this context, dedicated smartphone apps may be useful tools to provide immediate support to individuals in need. However, few studies to date have focused on the development and assessment of apps aimed at promoting emotional regulation for people with psychosis. OBJECTIVE The aim of this study was to evaluate the feasibility, acceptability, and potential clinical impact of a dedicated app (ChillTime) for individuals with psychotic disorders and concurrent SUD. The app design process followed recommendations for reducing cognitive effort on a mobile app. A total of 20 coping strategies regrouped in four categories (behavioral, emotional, cognitive, spiritual) were included in the app. METHODS This open pilot study followed a pre-post design. After the initial assessment, researchers asked participants to use the app as part of their treatment over a 30-day period. Feasibility was determined by the frequency of use of the app and measured using the number of completed strategies. Acceptability was determined by measuring ease of use, ease of learning, satisfaction, and perceived utility at the end of the 30-day study period based on responses to satisfaction questionnaires. Clinical scales measuring emotion regulation, substance use (ie, type of substance, amount taken, and frequency of use), and various psychiatric symptoms were administered at the beginning and end of the 30-day period. RESULTS A total of 13 participants were recruited from two first-episode psychosis clinics in Montreal, Quebec, Canada. All participants were symptomatically stable, were between 18 and 35 years of age (mostly men; 70% of the sample), and had a schizophrenia spectrum disorder with a comorbid substance use diagnosis. A total of 11 participants completed the study (attrition<20%). Approximately half of the participants used the tool at least 33% of the days (11-21 days). Cognitive and emotion-focused techniques were rated the highest in terms of usefulness and were the most frequently used. The majority of participants gave positive answers about the ease of use and the ease of learning the tool. A nonsignificant association of ChillTime use with negative symptoms and drug use was observed. No other statistically significant changes were observed. CONCLUSIONS The ChillTime app showed good feasibility (approximately half of the participants used the tool at least 33% of the days) and acceptability among people with schizophrenia spectrum disorder and SUD. Trends suggesting a potential impact on certain clinical outcomes will need to be replicated in larger-sample studies before any conclusion can be drawn.
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Affiliation(s)
| | - Tania Lecomte
- Département de Psychologie, Université de Montréal, Montreal, QC, Canada.,Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
| | - Stéphane Potvin
- Département de Psychologie, Université de Montréal, Montreal, QC, Canada.,Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
| | - Gabrielle Riopel
- Département de Psychologie, Université de Montréal, Montreal, QC, Canada
| | - Camille Vézina
- Département de Psychologie, Université de Montréal, Montreal, QC, Canada
| | - Marie Villeneuve
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
| | - Amal Abdel-Baki
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.,Département de Psychiatrie, Université de Montréal, Montreal, QC, Canada
| | - Yasser Khazaal
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada.,Département de Psychiatrie, Université de Montréal, Montreal, QC, Canada
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13
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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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Igra L, Sened H, Lavi-Rotenberg A, Pijnenborg M, Lysaker PH, Hasson-Ohayon I. Emotional experience and metacognition among people with schizophrenia: Analysis of session by session and outcome of metacognitive-oriented psychotherapy. J Psychiatr Res 2022; 156:460-466. [PMID: 36335836 DOI: 10.1016/j.jpsychires.2022.10.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 09/18/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Research suggests that in-session emotional experiences in psychotherapy promote both session and treatment outcomes across different clinical samples and treatment approaches. However, little is known about how this notion applies to clients with schizophrenia, who experience particular deficits related to emotional experience. To explore this question, we investigated the association between clients' emotional experience and their session outcome evaluations and metacognitive growth in a metacognitively-oriented treatment, Metacognitive Reflection and Insight Therapy (MERIT). MERIT is a recovery-oriented treatment approach for psychosis that focuses on recapturing a coherent sense of self and personal agency by enhancing metacognitive capacity. METHOD Five-hundred-and-sixty-three sessions of 37 clients with schizophrenia who took part in an ongoing MERIT trial were analyzed. The Emotional Experience Self-Report (EE-SR) and Outcome Rating Scale (ORS) were collected on a session-by-session basis. Levels of metacognition ware assessed pre- and post-treatment using the Metacognitive Assessment Scale-Abbreviated (MAS-A) coding system. We used multilevel modeling to test our session-level predictions, and linear regression analysis for treatment-level predictions. RESULTS Greater emotional experience, expression, and regulation within a session were associated with better session outcome. Regarding treatment level, greater emotional experience was associated with improvement in metacognitive mastery. CONCLUSIONS Our findings reveal that experiencing emotions in MERIT has significant implications for clients' subjective well-being during therapy sessions and for their ability to respond to psychological challenges using metacognitive knowledge. These findings lend weight to the idea that emotional experience is a key mechanism of change in metacognitive therapy for schizophrenia.
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Affiliation(s)
- Libby Igra
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel.
| | - Haran Sened
- Department of Psychology, University of Haifa, Haifa, Israel
| | | | - Marieke Pijnenborg
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, the Netherlands
| | - Paul H Lysaker
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
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15
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Stefancic A, Rogers RT, Styke S, Xu X, Buchsbaum R, Nossel I, Cabassa LJ, Stroup TS, Kimhy D. Development of the First Episode Digital Monitoring mHealth Intervention for People With Early Psychosis: Qualitative Interview Study With Clinicians. JMIR Ment Health 2022; 9:e41482. [PMID: 36331539 PMCID: PMC9675009 DOI: 10.2196/41482] [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: 08/25/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) technologies have been used extensively in psychosis research. In contrast, their integration into real-world clinical care has been limited despite the broad availability of smartphone-based apps targeting mental health care. Most apps developed for treatment of individuals with psychosis have focused primarily on encouraging self-management skills of patients via practicing cognitive behavioral techniques learned during face-to-face clinical sessions (eg, challenging dysfunctional thoughts and relaxation exercises), reminders to engage in health-promoting activities (eg, exercising, sleeping, and socializing), or symptom monitoring. In contrast, few apps have sought to enhance the clinical encounter itself to improve shared decision-making (SDM) and therapeutic relationships with clinicians, which have been linked to positive clinical outcomes. OBJECTIVE This qualitative study sought clinicians' input to develop First Episode Digital Monitoring (FREEDoM), an app-based mHealth intervention. FREEDoM was designed to improve the quality, quantity, and timeliness of clinical and functional data available to clinicians treating patients experiencing first-episode psychosis (FEP) to enhance their therapeutic relationship and increase SDM. METHODS Following the app's initial development, semistructured qualitative interviews were conducted with 11 FEP treatment providers at 3 coordinated specialty care clinics to elicit input on the app's design, the data report for clinicians, and planned usage procedures. We then generated a summary template and conducted matrix analysis to systematically categorize suggested adaptations to the evidence-based intervention using dimensions of the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) and documented the rationale for adopting or rejecting suggestions. RESULTS The clinicians provided 31 suggestions (18 adopted and 13 rejected). Suggestions to add or refine the content were most common (eg, adding questions in the app). Adaptations to context were most often related to plans for implementing the intervention, how the reported data were displayed to clinicians, and with whom the reports were shared. Reasons for suggestions primarily included factors related to health narratives and priorities of the patients (eg, focus on the functional impact of symptoms vs their severity), providers' clinical judgment (eg, need for clinically relevant information), and organizations' mission and culture. Reasons for rejecting suggestions included requests for data and procedures beyond the intervention's scope, concerns regarding dilution of the intervention's core components, and concerns about increasing patient burden while using the app. CONCLUSIONS FREEDoM focuses on a novel target for the deployment of mHealth technologies in the treatment of FEP patients-the enhancement of SDM and improvement of therapeutic relationships. This study illustrates the use of the FRAME, along with methods and tools for rapid qualitative analysis, to systematically track adaptations to the app as part of its development process. Such adaptations may contribute to enhanced acceptance of the intervention by clinicians and a higher likelihood of integration into clinical care. TRIAL REGISTRATION ClinicalTrials.gov NCT04248517; https://tinyurl.com/tjuyxvv6.
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Affiliation(s)
- Ana Stefancic
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - R Tyler Rogers
- Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, United States
| | - Sarah Styke
- Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, United States
| | - Xiaoyan Xu
- Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, United States
| | - Richard Buchsbaum
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Ilana Nossel
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States.,Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, United States
| | - Leopoldo J Cabassa
- Brown School of Social Work, Washington University in St Louis, St Louis, MO, United States
| | - T Scott Stroup
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States.,Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, United States
| | - David Kimhy
- Department of Psychiatry, Icahn School of Medicine, New York, NY, United States.,New York Mental Illness Research Education and Clinical Center, The James J Peters Veteran's Affairs Medical Center, Bronx, NY, United States
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16
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Panayi P, Berry K, Sellwood W, Campodonico C, Bentall RP, Varese F. The Role and Clinical Correlates of Complex Post-traumatic Stress Disorder in People With Psychosis. Front Psychol 2022; 13:791996. [PMID: 35369153 PMCID: PMC8967251 DOI: 10.3389/fpsyg.2022.791996] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Traumatic experiences and post-traumatic stress are highly prevalent in people with psychosis, increasing symptom burden, decreasing quality of life and moderating treatment response. A range of post-traumatic sequelae have been found to mediate the relationship between trauma and psychotic experiences, including the "traditional" symptoms of post-traumatic stress disorder (PTSD). The International Classification of Diseases-11th Edition recognizes a more complex post-traumatic presentation, complex PTSD (cPTSD), which captures both the characteristic symptoms of PTSD alongside more pervasive post-traumatic sequelae known as 'disturbances in self-organization' (DSOs). The prevalence and impact of cPTSD and DSOs in psychosis remains to be explored. In the first study of this kind, 144 participants with psychosis recruited from North West United Kingdom mental health services completed measures assessing trauma, PTSD and cPTSD symptoms and symptoms of psychosis. Forty-percent of the sample met criteria for cPTSD, compared to 10% who met diagnostic criteria for PTSD. PTSD and DSOs mediated the relationship between trauma and positive symptoms, controlling for dataset membership. Both PTSD and DSOs mediated the relationship between trauma and affective symptoms but did not explain a significant proportion of variance in negative symptoms. Cognitive and excitative symptoms of psychosis did not correlate with trauma, PTSD or DSO scores. These findings indicate the possible value of adjunct therapies to manage cPTSD symptoms in people with psychosis, pending replication in larger epidemiological samples and longitudinal studies.
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Affiliation(s)
- Peter Panayi
- Division of Psychology and Mental Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Katherine Berry
- Division of Psychology and Mental Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - William Sellwood
- Faculty of Health & Medicine, Division of Health Research, University of Lancaster, Lancaster, United Kingdom
| | - Carolina Campodonico
- School of Psychology and Computer Science, University of Central Lancashire, Lancashire, United Kingdom
| | - Richard P. Bentall
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Filippo Varese
- Division of Psychology and Mental Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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17
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Partridge O, Maguire T, Newman-Taylor K. How does attachment style affect psychosis? A systematic review of causal mechanisms and guide to future inquiry. Psychol Psychother 2022; 95:345-380. [PMID: 34687273 DOI: 10.1111/papt.12371] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 07/19/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE The link between attachment and psychosis is now well established, but less is known about the causal mechanisms underlying this relationship. This systematic review synthesises the studies that examine mediating mechanisms in the attachment and psychosis relationship, in both clinical and non-clinical samples. METHOD We conducted a database search (PsychINFO, MEDLINE, Web of Science) to identify all eligible studies irrespective of publication status, the language of article or article date. We assessed methodological quality and completed a narrative synthesis given the heterogeneity of studies to date. RESULTS We identified 17 papers, comprising 3,672 participants. The relationship between attachment and psychosis is mediated by four variables or groups of variables. There is good evidence for the causal role of affective factors (affective dysregulation and affective disturbances) and cognitive factors (e.g., self-beliefs and self-esteem and beliefs about symptoms). Affective factors differed by attachment style. Tentative evidence was found for the role of duration of untreated psychosis and baseline negative symptoms. CONCLUSIONS Cognitive and affective factors mediate the relationship between attachment style and psychosis. Whilst cognitive factors are routinely targeted in recommended psychological interventions for psychosis, affective factors and attachment style are less commonly considered. Psychological therapies may be improved by calibrating cognitive and affective interventions by attachment style, which should be subjected to experimental and then field studies to assess the impact on clinical and recovery outcomes. PRACTITIONER POINTS The relationship between attachment and psychosis is now well established, and studies have started to examine mediating mechanisms. Affective and cognitive factors mediate the attachment-psychosis relationship. Affective factors differ by attachment style. There is limited evidence for the duration of untreated psychosis and negative psychotic symptoms as mediating mechanisms, and research replication is needed. Cognitive factors are routinely targeted in recommended psychological therapies for psychosis, but affective factors and attachment style are less commonly considered. Research should be conducted into the effectiveness of psychological therapies which calibrate cognitive and affective interventions, according to attachment style.
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Affiliation(s)
| | - Tess Maguire
- Department of Psychology, University of Southampton, UK
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18
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Kalinich M, Ebrahim S, Hays R, Melcher J, Vaidyam A, Torous J. Applying machine learning to smartphone based cognitive and sleep assessments in schizophrenia. Schizophr Res Cogn 2022; 27:100216. [PMID: 34934638 PMCID: PMC8655108 DOI: 10.1016/j.scog.2021.100216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/09/2021] [Accepted: 09/19/2021] [Indexed: 11/19/2022] Open
Abstract
Background Methods Results Discussion
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Affiliation(s)
- Mark Kalinich
- Harvard Medical School, Boston, MA, USA
- Watershed Informatics, Inc., Boston, MA, USA
| | - Senan Ebrahim
- Harvard Medical School, Boston, MA, USA
- Delfina Inc., Boston, MA, USA
| | - Ryan Hays
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jennifer Melcher
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Aditya Vaidyam
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - John Torous
- Harvard Medical School, Boston, MA, USA
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Corresponding author at: Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, USA.
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19
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Lawlor C, Vitoratou S, Duffy J, Cooper B, De Souza T, Le Boutillier C, Carter B, Hepworth C, Jolley S. Managing emotions in psychosis: Evaluation of a brief DBT-informed skill group for individuals with psychosis in routine community services. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:735-756. [PMID: 35130354 PMCID: PMC9543194 DOI: 10.1111/bjc.12359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/19/2022] [Indexed: 12/02/2022]
Abstract
Objectives Individuals with psychosis report that emotion regulation (ER) difficulties are treatment priorities, yet little is known about how targeted ER interventions may help. We evaluated a new eight‐session Dialectical Behavioural Therapy (DBT)–informed skills group specifically adapted for individuals with psychosis: the Managing Emotions Group (MEG) in diverse, inner‐city community services. Method A mixed‐method design was utilised to assess the feasibility (acceptability and potential clinical impact) of local delivery of MEG. Uptake, completion (≥50% of sessions), post‐session satisfaction ratings, and thematic analysis of qualitative feedback from 12 completers assessed acceptability. Pre–post‐intervention changes in psychological distress, self‐reported ER difficulties, and adaptive ER skill use assessed potential clinical impact. Results Forty‐eight individuals (81% of attenders) completed the intervention (Mage = 43, 54% female) of whom 39 completed pre‐ and post‐group measures. Participants reported high satisfaction and meaningful improvements in understanding and managing emotions, with positive impact on daily life. Self‐reported psychological distress, ER difficulties, and adaptive ER skill use significantly improved, with medium‐to‐large pre‐post effects (d = 0.5–0.7) except lack of emotional clarity (d = 0.3). Conclusions MEG was feasible and acceptable, and a future feasibility randomised controlled trial is warranted. Practitioner points Individuals with psychosis report that support with their emotions is a priority. Brief interventions for emotion regulation difficulties are acceptable to individuals with psychosis and can be feasibly delivered in a local outpatient service. Distress and emotion regulation difficulties and skills improved significantly from pre–post treatment for clients completing the managing emotions group. Further implementation and evaluation are needed to support continued refinement to meet the needs and priorities of individuals with psychosis.
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Affiliation(s)
- Caroline Lawlor
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Silia Vitoratou
- Psychometrics and Measurement Lab, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - James Duffy
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ben Cooper
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Clair Le Boutillier
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Ben Carter
- Psychometrics and Measurement Lab, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Suzanne Jolley
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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20
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Silva DC, Rabelo-da-Ponte FD, Salati LR, Lobato MIR. Heterogeneity in gender dysphoria in a Brazilian sample awaiting gender-affirming surgery: a data-driven analysis. BMC Psychiatry 2022; 22:79. [PMID: 35105327 PMCID: PMC8808968 DOI: 10.1186/s12888-022-03727-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/18/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Population heterogeneity and the lack of clinical and sociodemographic information in transgender individuals with gender dysphoria (GD) remains a challenge for specialized services in mental health and surgical procedures. It aimed to identify and describe profiles in a sample waiting for gender-affirming surgery. METHODS A sample of 100 outpatients with GD was assessed through a structured interview, Emotion Regulation Difficulty Scale (DERS), Ruminative Response Scale (RRS), Depression, Anxiety and Stress Scale (DASS-21) and Life Satisfaction scale (SWLS). Cluster analysis was used to identify different profile categories. RESULTS Two subgroups with different profiles were identified: with less clinical severity (LCS) and with high clinical severity (HCS) on emotional dysregulation, acute symptoms of depression, anxiety, stress and association with mental rumination. The HCS cluster had greater vulnerability in terms of psychiatric history, use of psychotropic drugs, HIV positive, child abuse and suicidal behavior. CONCLUSION Different profiles were found regarding the vulnerability to mental health in a sample of transgender people with GD who seek a public hospital service for the same clinical-surgical objective. Longitudinal studies are essential to monitor the impact of these contrasts and to target personalized therapeutic approaches in the prevention of psychiatric disorders.
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Affiliation(s)
- Dhiordan Cardoso Silva
- Transdisciplinary Gender Identity Program, Department of Psychiatry of Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil. .,Graduate Program in Psychiatry and Behavioral Sciences, Medical School of the Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Porto Alegre, RS, 90035-903, Brazil.
| | - Francisco Diego Rabelo-da-Ponte
- grid.8532.c0000 0001 2200 7498Graduate Program in Psychiatry and Behavioral Sciences, Medical School of the Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Porto Alegre, RS 90035-903 Brazil ,grid.414449.80000 0001 0125 3761Molecular Psychiatry Laboratory, Department of Psychiatry of Hospital de Clínicas de Porto Alegre, Porto Alegre, RS Brazil
| | - Leonardo Romeira Salati
- grid.414449.80000 0001 0125 3761Transdisciplinary Gender Identity Program, Department of Psychiatry of Hospital de Clínicas de Porto Alegre, Porto Alegre, RS Brazil
| | - Maria Inês Rodrigues Lobato
- grid.414449.80000 0001 0125 3761Transdisciplinary Gender Identity Program, Department of Psychiatry of Hospital de Clínicas de Porto Alegre, Porto Alegre, RS Brazil ,grid.8532.c0000 0001 2200 7498Graduate Program in Psychiatry and Behavioral Sciences, Medical School of the Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Porto Alegre, RS 90035-903 Brazil
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21
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Pathways from insecure attachment to paranoia: the mediating role of emotion regulation. Behav Cogn Psychother 2022; 50:404-417. [DOI: 10.1017/s1352465822000029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Background:
Paranoia is common across the clinical and non-clinical spectrum. Cognitive behavioural therapy for psychosis currently yields modest results, warranting research into symptom-specific maintenance factors to improve outcomes. There is strong evidence of a relationship between insecure attachment and increased paranoia, but little is known about the mediating mechanisms. Emotion dysregulation is associated with both insecure attachment and paranoia, and a candidate causal mechanism.
Aims:
This study aimed to determine if emotion dysregulation mediates the association between attachment and paranoia.
Method:
Sixty-two individuals with elevated paranoia were recruited from NHS services and community settings across the South of England. Mediation analyses were conducted on trait attachment, emotion regulation and paranoia variables, which were collected at one time point.
Results:
As predicted, emotion dysregulation mediated the relationship between attachment avoidance and paranoia, and between attachment anxiety and paranoia. Emotion suppression did not mediate the relationship between attachment avoidance and paranoia, possibly due to power. Attachment avoidance correlated with deactivating emotion regulation strategies (e.g. lack of emotional awareness) and attachment anxiety correlated with hyperactivating emotion regulation strategies (e.g. impulse control difficulties). Both deactivating and hyperactivating strategies correlated with paranoia.
Conclusion:
Emotion dysregulation is not routinely targeted in cognitive behavioural therapy for psychosis. This study suggests that incorporating emotion regulation strategies in therapy may improve clinical outcomes. Experimental studies are now required to support a causal argument, and pilot intervention studies should investigate if emotion regulation skills development (aligned with attachment style) is effective in reducing non-clinical and clinical paranoia.
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22
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Langer ÁI, Wardenaar K, Wigman JTW, Ulloa JL, Núñez D. A Latent Profile Analysis of Psychotic Experiences, Non-psychotic Symptoms, Suicidal Ideation and Underlying Mechanisms in a Sample of Adolescents From the General Population. Front Psychiatry 2022; 13:926556. [PMID: 35832591 PMCID: PMC9271879 DOI: 10.3389/fpsyt.2022.926556] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/30/2022] [Indexed: 11/23/2022] Open
Abstract
Psychotic experiences (PEs) are prevalent in the general population, particularly in adolescents. PEs are associated with various negative outcomes such as psychotic, depressive, anxiety and post-traumatic stress disorders and suicidal behavior. Recent studies in the general population have suggested that what makes PEs relevant is not so much the experiences per se, but their association with non-psychotic comorbidity and other transdiagnostic domains. Thus, there is a need for a better understanding of how PEs exist in a larger psychopathological context in adolescents. In the present study we aimed to explore this, using latent profile analysis (LPA) to identify different patterns in which PEs, psychiatric symptoms and psychological processes co-occur. LPA was conducted using data from an adolescent general population subsample (n = 335) with PEs. We conducted LPA, using measures of PEs, psychiatric symptoms and behaviors (depression, anxiety post-traumatic stress disorder and suicidal behavior) and cognitive and affective processes of entrapment/defeat and emotional regulation as manifest variables. We found that the best fit was obtained with a four-class solution that distinguished primarily between different levels of overall severity: "low symptomatology" (19.1%), "mild-moderate symptomatology" (39.4%), "moderate symptomatology" (33.7%); "high symptomatology" (7.8%). Levels of depression, post-traumatic stress symptoms and defeat/entrapment were most differentiated between classes. The high symptomatology group showed the highest scores in all psychiatric symptoms suicidal ideation, and emotional/cognitive domains, except in cognitive reappraisal. This group also showed the highest usage of emotional suppression. Our results suggest that the assessment of mental health risk in adolescents should be aware that PEs exist in a broad context of other domains of psychopathology and transdiagnostic cognitive and affective processes.
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Affiliation(s)
- Álvaro I Langer
- Mind-Body Lab, Institute of Psychological Studies, Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile.,Agencia Nacional de Investigaciòn y Desarrollo (ANID), Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Santiago, Chile.,Associative Research Program, Center of Cognitive Sciences, Faculty of Psychology, Universidad de Talca, Talca, Chile
| | - Klaas Wardenaar
- Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, Netherlands
| | - Johanna T W Wigman
- Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, Netherlands
| | - José Luis Ulloa
- Agencia Nacional de Investigaciòn y Desarrollo (ANID), Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Santiago, Chile.,Associative Research Program, Center of Cognitive Sciences, Faculty of Psychology, Universidad de Talca, Talca, Chile
| | - Daniel Núñez
- Agencia Nacional de Investigaciòn y Desarrollo (ANID), Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Santiago, Chile.,Associative Research Program, Center of Cognitive Sciences, Faculty of Psychology, Universidad de Talca, Talca, Chile
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23
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Barbato M, Arora T, Al Hemeiri S, AlJassmi MA. Looking within: Interoceptive sensibility in young adults with psychotic-like experiences. Early Interv Psychiatry 2021; 15:1705-1712. [PMID: 33442933 DOI: 10.1111/eip.13117] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/13/2020] [Accepted: 01/04/2021] [Indexed: 02/06/2023]
Abstract
AIM Interoception is the ability to sense internal bodily changes and research indicates that it may play a role in the development of mental illness. In recent years, preliminary evidence has shown that interoception is impaired in people with psychosis. Interoceptive sensibility, a meta-cognitive aspect of interoception, has never been studied across the psychosis continuum. The present study aimed at assessing interoceptive sensibility in youth with psychotic-like experiences. METHOD We invited a sample of young adults (N = 609; age 19-21 years) to complete an online survey that included a measure of interoceptive sensibility (the Multidimensional Assessment of Interoceptive Awareness-2) and the Community Assessment of Psychotic Experiences-Positive Scale -15 (CAPE-P15). Using the recommended cutoff for the CAPE-P15, the overall sample was divided into two groups (high/low risk for psychosis). RESULTS Significant group differences were observed in several dimensions of interoceptive sensibility. A logistic regression analysis indicated that scores in the subscales of Not-Distracting, Not-Worrying, Attention-Regulation, Emotional Awareness, Body Listening, and Trusting significantly predicted increased risk for psychosis. CONCLUSION Abnormal interoceptive sensibility may be a vulnerability marker for psychosis. These results, however, await further validation from additional comprehensive, longitudinal studies. Enhanced interoceptive sensibility has been reported following contemplative training, thus creating opportunities for future interventions to delay or prevent psychotic illness.
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Affiliation(s)
- Mariapaola Barbato
- Department of Psychology, College of Natural and Health Sciences, Zayed University, Dubai, United Arab Emirates
| | - Teresa Arora
- Department of Psychology, College of Natural and Health Sciences, Zayed University, Dubai, United Arab Emirates
| | | | - Maryam A AlJassmi
- Department of Psychology, College of Natural and Health Sciences, Zayed University, Dubai, United Arab Emirates
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Testing whether implicit emotion regulation mediates the association between discrimination and symptoms of psychopathology in late childhood: An RDoC perspective. Dev Psychopathol 2021; 33:1634-1647. [PMID: 34323206 DOI: 10.1017/s0954579421000638] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Discrimination has been associated with adverse mental health outcomes, though it is unclear how early in life this association becomes apparent. Implicit emotion regulation, developing during childhood, is a foundational skill tied to a range of outcomes. Implicit emotion regulation has yet to be tested as an associated process for mental illness symptoms that can often emerge during this sensitive developmental period. Youth aged 9-11 were recruited for the Adolescent Brain Cognitive Development (ABCD) study. Associations between psychotic-like experiences, depressive symptoms, and total discrimination (due to race, ethnicity, nationality, weight, or sexual minority status) were tested, as well as associations with implicit emotion regulation measures (emotional updating working memory and inhibitory control). Analyses examined whether associations with symptoms were mediated by implicit emotion regulation. Discrimination related to decreased implicit emotion regulation performance, and increased endorsement of depressive symptoms and psychotic-like experiences. Emotional updating working memory performance partially mediated the association between discrimination and psychotic-like experiences, while emotional inhibitory control did not. Discrimination and implicit emotion regulation could serve as putative transdiagnostic markers of vulnerability. Results support the utility of using multiple units of analysis to improve understanding of complex emerging neurocognitive functions and developmentally sensitive periods.
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Ryan A, Crehan E, Khondoker M, Fell M, Curtin R, Johns LC. An emotional regulation approach to psychosis recovery: The Living Through Psychosis group programme. J Behav Ther Exp Psychiatry 2021; 72:101651. [PMID: 33667827 DOI: 10.1016/j.jbtep.2021.101651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 01/25/2021] [Accepted: 02/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Research indicates the value of targeting emotional regulation (ER) skills in psychological interventions for psychosis. These skills can be delivered in a group format, thereby increasing access to therapy. This pilot study examined the acceptability and clinical effects of teaching ER skills in The Living Through Psychosis (LTP) group programme. METHODS Patients with a psychotic illness were offered the LTP programme, comprising eight sessions over four weeks. Measures were completed by 55 participants. Acceptability was assessed by attendance rates and group cohesion. Measures of intervention targets, recovery and clinical outcomes were completed at baseline, pre-group, post-group, and one-month follow-up. RESULTS High group attendance and cohesion support the acceptability of the group. Participants reported less difficulty with ER (Coeff. = -8.29, 95% CI: -13.40 to -3.18, within participant uncontrolled effect size (ES) d = 0.29), increased mindful relating to distressing symptoms (Coeff. = 11.20, 95% CI: 7.02 to 15.38, d = 0.65), and improvements in recovery dimensions (Coeff. = 10.07, 95% CI: 5.6 to 14.54, d = 0.42) from pre-to post-intervention, and maintained at one-month follow-up. Participants' hallucinations and delusions reduced from pre-intervention to follow-up (t(18) = 4.64, p < 0.001; t(18) = 5.34, p < 0.001). There was no change in fear of relapse. LIMITATIONS The uncontrolled, pre-post design precluded blinded assessments, and may have inflated effect sizes. Other factors may have contributed to the improvements. CONCLUSIONS The LTP programme was acceptable to people with psychosis. The preliminary findings indicate the potential utility of teaching ER and mindfulness skills in a brief group programme. Findings require replication in a randomized controlled trial.
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Affiliation(s)
- Aisling Ryan
- School of Psychology, Trinity College Dublin, Ireland; Health Service Executive, Ireland
| | - Edel Crehan
- Department of Psychology, St Patrick's Mental Health Services, Dublin, Ireland
| | | | - Mary Fell
- School of Psychology, Trinity College Dublin, Ireland; Health Service Executive, Ireland
| | - Roisin Curtin
- Department of Psychology, St Patrick's Mental Health Services, Dublin, Ireland
| | - Louise C Johns
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
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Bahlinger K, Lincoln TM, Clamor A. Are Acute Increases and Variability in Emotion Regulation Strategies Related to Negative Affect and Paranoid Thoughts in Daily Life? COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10253-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Background
Negative affect reliably predicts paranoid thoughts. Previous studies point to the importance of emotion regulation for paranoid thoughts but have not yet focused on effects of acute increases and variability in strategy use.
Methods
We conducted an experience-sampling study for one week in a subclinical sample. Acute increases in the intensity of strategy use from one measurement point until the next, between-strategy variability (i.e., standard deviation between all strategies at one measurement point), and within-strategy variability (i.e., standard deviation of each strategy over one day) were analyzed for effects on negative affect and paranoid thoughts.
Results
Multi-level-models indicated that acute increases in acceptance and reappraisal are associated with less negative affect. Acute increases in acceptance, but not in reappraisal, were related to less paranoid thoughts. In contrast, acute increases in rumination and suppression were associated with more negative affect and paranoid thoughts. Between- and within-strategy variability were no significant predictors.
Conclusions
Acute increases in the intensity of but not variability in emotion regulation strategies are related to negative affect and paranoid thoughts in daily life. Future studies are needed to examine whether improving emotion regulation leads to sustainable reductions in symptoms.
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Núñez D, Ordóñez-Carrasco JL, Fuentes R, Langer ÁI. Experiential avoidance mediates the association between paranoid ideation and depressive symptoms in a sample from the general population. J Psychiatr Res 2021; 139:120-124. [PMID: 34058650 DOI: 10.1016/j.jpsychires.2021.05.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 05/06/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
Psychotic experiences are prevalent in the general population and are associated with negative outcomes, including depressive symptoms. The mechanisms underlying this relationship remain unclear, but new insights could be obtained by exploring the role of transdiagnostic processes such as experiential avoidance, defined as a person's attempts or desires to suppress unwanted internal experiences like thoughts, emotions, memories, or bodily sensations. Studies analyzing the link between negative emotional states and psychotic experiences are scant. We explored the association between a specific kind of psychotic experience (paranoid ideation), experiential avoidance, and depressive, anxiety, and stress symptoms in a sample from the general population. We found that experiential avoidance partially mediates the associations between paranoid ideation and stress and anxiety symptoms and that it fully mediates the association between paranoid ideation and depressive symptoms. Our results suggest that the presence of paranoid ideation and the usage of experiential avoidance to cope with it are vulnerability factors associated with psychological distress.
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Affiliation(s)
- Daniel Núñez
- Faculty of Psychology, Universidad de Talca, Chile; Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Chile; Associative Research Program, Center of Cognitive Sciences, Faculty of Psychology, Universidad de Talca, Chile
| | | | - Reiner Fuentes
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Chile; Mind-Body Lab, Centro de Salud Universitario, Dirección de Asuntos Estudiantiles (DAE), Universidad Austral de Chile, Valdivia, Chile
| | - Álvaro I Langer
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Chile; Associative Research Program, Center of Cognitive Sciences, Faculty of Psychology, Universidad de Talca, Chile; Mind-Body Lab, Instituto de Estudios Psicológicos, Facultad de Medicina, Universidad Austral de Chile, Chile.
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Eddy CM, Hansen PC. Alexithymia Is a Key Mediator of the Relationship Between Magical Thinking and Empathy. Front Psychiatry 2021; 12:719961. [PMID: 34504448 PMCID: PMC8421603 DOI: 10.3389/fpsyt.2021.719961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/28/2021] [Indexed: 11/24/2022] Open
Abstract
Thought action fusion (TAF), whereby internal thoughts are perceived to exert equivalent effects to external actions, is a form of magical thinking. Psychiatric disorders associated with TAF (e.g. schizophrenia; obsessive compulsive disorder) can feature atypical social cognition. We explored relationships between TAF and empathy in 273 healthy young adults. TAF was directly correlated with higher personal distress, but not perspective taking, fantasy or empathic concern. TAF moral (the belief that thinking about an action/behaviour is morally equivalent to actually performing that behaviour) was predicted by emotion contagion, alexithymia and need for closure. TAF likelihood (the belief that simply having a thought about an event makes that event more likely to occur) was predicted by personal distress, sense of agency and alexithymia. Both cognitive (TAF and negative sense of agency) and emotional (emotion contagion, alexithymia) factors contributed to personal distress. TAF, negative sense of agency and personal distress mediated the effect of emotion contagion on alexithymia. Our findings reveal complex relationships between emotional processes and TAF, shedding further light on the social cognitive profile of disorders associated with magical thinking. Furthermore, they emphasise the potential importance of alexithymia and emotion contagion as mediators or potential risk factors in the development of psychiatric symptoms linked to TAF, such as intrusive thoughts about harm to others.
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Affiliation(s)
- Clare M Eddy
- Birmingham and Solihull Mental Health NHS Foundation Trust and College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Peter C Hansen
- Centre for Human Brain Health and School of Psychology, University of Birmingham, Birmingham, United Kingdom
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