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

Deconstructing the nature of emotion regulation impairments at the identification, selection, and implementation stages in individuals at clinical high-risk for psychosis

BACKGROUND

Psychotic disorders are characterized by emotion regulation abnormalities that predict greater symptom severity and poor functional outcomes. However, it is unclear whether these abnormalities also occur in individuals at clinically high risk for psychosis (CHR). The current study used ecological momentary assessment (EMA) to address this question and examined the nature of abnormalities at three stages of emotion regulation (identification, selection, implementation).

METHODS

Participants included 120 CHR and 59 CN who completed 1 week of EMA surveys evaluating emotional experience, emotion regulation, context, and symptoms. Multi-level models examined concurrent and time-lagged effects.

RESULTS

CHR evidenced elevated state negative affect and abnormalities at all three stages of emotion regulation. At the identification stage (i.e., determining the need to regulate), regulatory attempts were made too frequently and with too much effort at low levels of negative affect and not frequently enough and with insufficient effort at high levels of negative affect. Selection stage abnormalities (i.e., choosing the exact strategy to attempt based on context) were characterized by increased frequency of selecting individual strategies and greater polyregulation (i.e., use of multiple strategies concurrently). Implementation stage (i.e., executing the selected strategy) abnormalities were indicated by being less effective at decreasing the intensity of negative affect from time t to t + 1.

CONCLUSIONS

It is not only heightened stress reactivity that confers risk for psychosis, but also abnormalities in applying emotion regulation strategies to control the stress response. The profile of abnormalities observed in CHR is similar to schizophrenia, suggesting treatment targets that transcend phases of psychotic illness.

Impact of age of onset on the course of chronic schizophrenia: factors associated with first hospitalization in a large-scale cross-sectional study

This study aims to identify the factors influencing the age of first hospitalization in patients with chronic schizophrenia, focusing on clinical features and blood parameters. A total of 1271 patients diagnosed with chronic schizophrenia were recruited from 17 psychiatric hospitals across China. Demographic and clinical data, including age of first hospitalization, were collected. The study also included assessments of psychiatric symptoms, duration of untreated psychosis (DUP), and various blood parameters. Statistical analyses were conducted to examine the relationships between these factors and the age of first hospitalization. The average age of first hospitalization was 28.07 ± 9.993 years. Single patients and those with a family history of mental illness were hospitalized at a younger age. Patients with suicidal ideation or behavior also had an earlier hospitalization age compared to those without such history. Regression analysis revealed that marital status (single), family history of mental illness, and suicide ideation or behavior were significant risk factors for earlier hospitalization age. Conversely, DUP, total protein (TP), and low-density lipoprotein (LDL) levels were positively correlated with the age of first hospitalization, while antipsychotic medication dosage and albumin (ALB) levels were negatively correlated. The study identifies significant demographic, clinical, and biochemical factors associated with the age of first hospitalization in chronic schizophrenia patients in China. These findings underscore the importance of early intervention and targeted support for high-risk groups to improve treatment outcomes.

Pixels and perception: Mapping the association between digital media and psychotic-like experiences in adolescents

INTRODUCTION

Psychotic-like experiences (PLEs) during adolescence can lead to psychotic disorders. Digital media usage has been suggested to link to PLEs, but research is limited on how different types of screen exposure may differentially relate to PLEs over time. This study aimed to examine longitudinal associations between screen usage patterns and PLEs in adolescents.

METHODS

Participants comprised 11,876 adolescents assessed annually from ages 9-12 years as part of the Adolescent Brain Cognitive Development study (ABCD). Screen usage (TV, video games, online video, social media, texting, video chat) and PLEs were assessed via self-report. Longitudinal network analysis models were estimated to examine connections between screen usage types and PLEs across three time points.

RESULTS

Two clusters were formed, including digital media for socializing (e.g., social media/texting/video chat) and digital media for entertainment (e.g., online video/video games/TV). Texting and online video(s) had the highest centrality at each time point, suggesting importance in the network. PLE symptoms of hallucinations and concentration difficulties exhibited higher centrality than other symptoms. Online video and TV were influential bridges between screen usage and PLEs. Network structure significantly differed between ages 9-10 and 10-12 years, but global strength was unchanged over time.

DISCUSSION

Results highlight the importance of understanding the associations between specific screen usage types and PLE symptoms. Texting and online video usage appear most influential in the development of adolescent PLEs over time. Findings can inform targeted interventions to promote healthy screen habits and reduce PLEs in at-risk youth.

A Latent Profile Analysis of Emotion Regulation in Relation to Distress of Symptoms in Youth with Prodromal Psychotic Symptoms

(1) Background: Although abnormal emotion regulation is a key characteristic of youth with prodromal psychotic symptoms and is closely related to the degree of distress caused by these symptoms, research on the internal heterogeneity of emotion regulation within this clinically high-risk population has been insufficient. (2) Methods: The current study analyzed data from 394 college students with prodromal psychotic symptoms, using latent profile analysis (LPA) to identify emotion regulation profiles based on differences in expressive suppression and cognitive reappraisal. One-way ANOVA was employed to examine the relationship between the identified latent profiles and distress of symptoms. (3) Results: Three latent profiles were identified: "high cognitive reappraisal group" (n = 117, 29.70%), "moderate cognitive reappraisal group" (n = 233, 59.14%), and "low cognitive reappraisal group" (n = 44, 11.16%). Significant differences in distress of negative symptoms (F = 9.122, p < 0.05) and perceptual abnormalities (F = 3.103, p < 0.05) were observed across the latent profiles but not in unusual thought content and specific perceptual abnormalities (both p > 0.05). The "low cognitive reappraisal group" exhibited the most severe distress of symptoms, followed by the "moderate cognitive reappraisal group", while the "high cognitive reappraisal group" experienced the least distress. (4) Conclusions: The current study provides evidence for the heterogeneity of emotion regulation among youth with prodromal psychotic symptoms and reveals differences in distress of perceptual abnormalities and negative symptoms between the latent profiles of emotion regulation. These findings support the development of targeted psychological interventions to alleviate the distress of symptoms and improve quality of life.

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

Background

Beliefs about the usefulness and controllability of emotions are associated with emotion regulation and psychological distress in the general population. Although individuals with schizophrenia-spectrum disorders evidence emotion regulation abnormalities, it is unclear whether emotional beliefs contribute to these difficulties and their associated poor clinical outcomes.

Methods

Participants included 72 individuals with schizophrenia-spectrum diagnoses (outpatients with schizophrenia n = 38; youth at clinical high-risk for psychosis, n = 34) and healthy controls (CN: n = 61) who completed the Emotional Beliefs Questionnaire, Emotion Regulation Questionnaire, and measures of clinical symptom severity.

Results

Those with schizophrenia-spectrum diagnoses reported believing that emotions were less controllable than CN; however, groups did not differ regarding beliefs about the usefulness of emotion. Greater beliefs of the uncontrollability of emotion were associated with greater use of suppression, less use of reappraisal, and increased negative symptoms. Emotion regulation partially mediated the association between emotional beliefs and negative symptoms.

Conclusions

Individuals in the schizophrenia-spectrum display superordinate beliefs that emotions are uncontrollable. These beliefs may influence emotion regulation strategy selection and success, which contributes to negative symptoms. Findings suggest that beliefs of emotional uncontrollability reflect a novel process related to both emotion regulation and negative symptoms that could be targeted in psychosocial treatments.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10608-023-10357-w.

Effectiveness of Acceptance and Commitment Therapy on the Positive and Negative Symptoms and Emotion Regulation of Patients with Schizophrenia Spectrum Disorders: A Single-case Clinical Trial Study

Background: The literature suggests the increasing application of acceptance and commitment therapy (ACT) for people with schizophrenia spectrum disorders (SSD). Objectives: This study aimed to determine the effectiveness of ACT on the positive and negative symptoms and emotion regulation of patients with SSD. Methods: The experimental design of the current study was an AB (baseline and intervention phases) along with the follow-up phase, in addition to Treatment-As-Usual (TAU), ACT sessions were held for the participants. Among the 20 participants who had inclusion criteria to the study, five participant (three men and two women in the age range of 32 - 43 years) were randomly allocated to participate in the intervention through drawing and evaluated using the Positive and Negative Syndrome Scale (PANSS) and Difficulties in Emotion Regulation Scale (DERS) in three phases of baseline, intervention, and follow-up. For data analysis, non-overlapping indices and Cohen's d effect size were measured, and visual diagrams were plotted for interpretation. Results: The present results showed that the effect sizes of psychotic symptoms in the first to fifth participants were 1.7, 1.9, 0.6, 4, and 1.4, respectively in the intervention phase relative to the baseline; the effect size was only large for the fourth participant. Also, the effect sizes of emotion regulation in the first to fifth participants were 0.8, 1.6, 1.5, 1.2, and 2.7, respectively; the effect size was only large for the fifth participant. Conclusions: The results of data analysis showed that ACT is effective in reducing psychotic symptoms and improving emotion regulation. The effect size of ACT was the largest for the fourth participant; medium for the first, second, and fifth participants; and small for the third participant.