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Gong J, Luo Y, He Y, Zhou L, Zhao L, Liu J. Epidemiology of psychotic-like experiences by subtypes and their relationship with emotional regulation and affective lability among Chinese college students. Schizophr Res 2022; 244:39-45. [PMID: 35569436 DOI: 10.1016/j.schres.2022.02.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/26/2022] [Indexed: 10/18/2022]
Abstract
Although psychotic-like experiences (PLEs) are transient and not pathognomonic for psychiatric disorders, they may increase the risk of concurrent and future psychiatric disorders. However, the prevalence of PLEs and the different effects of PLE subtypes on mood outcomes are still unclear. Thus, this study seeks to investigate the prevalence of PLE subtypes and explore their relationship with the use of specific emotion regulation strategies and the level of affective lability among college students. The history of PLEs, the level of affective lability, and the use of specific emotion regulation strategies were assessed via self-reported questionnaires, and 1905 college students and 1812 college students were included in separate analyses. This study found that 14.44% of college students reported ever experiencing any of the five PLEs, with males reporting more PLE symptoms and a higher number of PLEs than females. Different PLE subtypes had different effects on the use of specific emotion regulation strategies (cognitive reappraisal or suppression) and the level of affective lability and also showed gender differences. Cognitive reappraisal and suppression differently predicted affective lability in males and females, and cognitive reappraisal mediated the relationship between hearing voices in PLEs and affective lability in males. In conclusion, PLEs were common in Chinese college students and gender differences were revealed in the prevalence of PLE subtypes. PLEs were associated with the use of specific emotion regulation strategies and the level of affective lability. Cognitive reappraisal may be a promising target for intervention aimed at relieving the effect of PLEs in non-clinical individuals.
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Affiliation(s)
- Jingbo Gong
- Shanghai Changning Mental Health Center, Shanghai 200335, China; Department of Applied Psychology, Hunan university of Chinese medicine, Changsha, Hunan, China
| | - Yanhong Luo
- Department of Applied Psychology, Hunan university of Chinese medicine, Changsha, Hunan, China
| | - Yuqiong He
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Lihua Zhou
- College of Education Science, Hengyang Normal University, Hengyang, Hunan 421001, China
| | - Lishun Zhao
- Department of Applied Psychology, Hunan university of Chinese medicine, Changsha, Hunan, China
| | - Jianbo Liu
- Department of Child Psychiatry of Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen Institute of Mental Health, Shenzhen Key Laboratory of Mental Health, Shenzhen, China.
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2
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Fekih-Romdhane F, Dissem N, Cheour M. How did Tunisian university students cope with fear of COVID-19? A comparison across schizotypy features. PERSONALITY AND INDIVIDUAL DIFFERENCES 2021; 178:110872. [PMID: 33814659 PMCID: PMC8009054 DOI: 10.1016/j.paid.2021.110872] [Citation(s) in RCA: 3] [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: 12/13/2020] [Revised: 03/18/2021] [Accepted: 03/21/2021] [Indexed: 11/23/2022]
Abstract
Background Little consideration has been given to the impact of COVID-19 on people at risk of psychosis despite their particular preexisting vulnerability. We aimed to examine the role of coping strategies in determining the levels of fear in nonclinical students with high levels of self-reported schizotypal personality traits as compared to low-schizotypy controls. Method This was a cross-sectional survey. The Schizotypal Personality Questionnaire, the Fear of COVID-19 Scale and The Brief-Coping Orientation to Problems Experienced were used. Results High-schizotypy students had significantly higher maladaptive strategies scores and higher levels of fear of COVID-19 as compared to low-schizotypy students. Multivariate analyses have shown that high-schizotypy individuals were likely to rely on coping responses that are maladaptive (venting) and have potential exacerbating effects on fear of COVID-19, whereas low-schizotypy individuals were likely to use adaptive responses (acceptance) that seemed to be effective in reducing fear of COVID-19. Conclusion This study provided preliminary cross-sectional evidence for a differential impact of COVID-19 on individuals according to their schizotypy features. However, larger longitudinal population-based studies are necessary to confirm our findings.
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Affiliation(s)
- Feten Fekih-Romdhane
- Tunis El Manar University, Faculty of Medicine of Tunis, Tunisia.,Razi Hospital, Mannouba, Tunisia
| | - Nouha Dissem
- Tunis El Manar University, Faculty of Medicine of Tunis, Tunisia
| | - Majda Cheour
- Tunis El Manar University, Faculty of Medicine of Tunis, Tunisia.,Razi Hospital, Mannouba, Tunisia
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3
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Opoka SM, Ludwig L, Mehl S, Lincoln TM. An experimental study on the effectiveness of emotion regulation in patients with acute delusions. Schizophr Res 2021; 228:206-217. [PMID: 33453692 DOI: 10.1016/j.schres.2020.11.054] [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: 04/14/2020] [Revised: 08/28/2020] [Accepted: 11/29/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patients with psychotic disorders report to apply more maladaptive and less adaptive emotion-regulation (ER) strategies compared to healthy controls. However, few studies have used experimental designs to investigate the success in ER and the results of those at hand are equivocal. AIM This study investigated whether patients with delusions show problems in downregulating negative affect via cognitive ER-strategies. METHOD Patients with schizophrenia spectrum disorders and acute delusions (n = 78) and healthy controls (n = 41) took part in an ER-experiment, in which they were instructed to downregulate anxiety and sadness via three ER-strategies (reappraisal, distraction, acceptance) or not to regulate their emotions (control-condition). ER-success was measured as the change in subjective emotion-intensity and physiological indicators (skin conductance and heart rate) from before to after regulation and was analyzed with mixed-repeated-measures ANOVAs. RESULTS We found a significant effect of the ER-strategy in the sense that the subjective emotion-intensity was significantly lower after applying the reappraisal- and distraction-strategies than after the just view-condition (p's < .001). This effect was not found for the acceptance strategy (p = .060). There was no ER-strategy ∗ time ∗ group interaction-effect F(4.918, 575.416) = 0.778, p = .564, ƞ2partial = 0.007. In all conditions, skin conductance decreased from pre- to post regulation (p < .001). CONCLUSION Our results indicate that patients with acute delusions can successfully apply cognitive ER-strategies. Before pursuing the relevant clinical implications of this finding, further research is needed to explore the role that the type of instruction has on ER-success and the extent to which the findings can be generalized to real life settings.
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Affiliation(s)
- Sandra M Opoka
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, 20146 Hamburg, Germany.
| | - Lea Ludwig
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, 20146 Hamburg, Germany
| | - Stephanie Mehl
- Department of Psychiatry and Psychotherapy & Center for Mind, Brain and Behavior (CMBB), Faculty of Medicine, Philipps-University of Marburg, 35039 Marburg, Germany; Faculty of Health and Social Work, Frankfurt University of Applied Sciences, 60318 Frankfurt am Main, Germany
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, 20146 Hamburg, Germany
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4
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Bortolon C, Capdevielle D, Dubreucq J, Raffard S. Persecutory ideation and anomalous perceptual experiences in the context of the COVID-19 outbreak in France: what's left one month later? J Psychiatr Res 2021; 134:215-222. [PMID: 33444930 DOI: 10.1016/j.jpsychires.2020.12.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/04/2020] [Accepted: 12/17/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Beyond the effects of the coronavirus pandemic on the public's health, the length of lockdown and its possible psychological impacts on populations is heavily debated. However, the consequences of lockdown on psychotic symptoms have been poorly investigated. METHODS An online survey was run from April 13 to May 11, 2020; a total of 728 French subjects from the general population were included in the study. We assessed the perceived impact of the COVID-19 outbreak, length of isolation, diagnosis/symptoms/hospitalisation related to the COVID-19 (oneself and family). Paranoid ideations and hallucination-like experiences were assessed via the Paranoia Scale and the Cardiff Anomalous Perceptions Scale, respectively. Self-reported measures of negative affect, loneliness, sleep difficulties, jumping to conclusion bias, repetitive thoughts, among others, were also included. RESULTS Final regression model for paranoia indicated that socio-demographic variables (age, sex and education), loneliness, cognitive bias, anxiety, experiential avoidance, repetitive thoughts and hallucinations were associated with paranoia (R2 = 0.43). For hallucinations, clinical variables as well as the quality of sleep, behavioural activation, repetitive thoughts, anxiety and paranoia were associated with hallucinations in our sample (R2 = 0.27). Neither length of isolation nor the perceived impact of the COVID-19 pandemic were associated with psychotic experiences in the final models. CONCLUSIONS No evidence was found for the impact of isolation on psychotic symptoms in the general population in France one month after the lockdown. It nevertheless confirms the preeminent role of several factors previously described in the maintenance and development of psychotic symptoms in the context of a pandemic and lockdown measures.
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Affiliation(s)
- Catherine Bortolon
- Laboratoire Inter-universitaire de Psychologie: Personnalité, Cognition et Changement Social - Université Grenoble Alpes, Grenoble, France; C3R - Réhabilitation Psychosociale et Remédiation Cognitive, Centre Hospitalier Alpes Isère, Grenoble, France.
| | - Delphine Capdevielle
- University Department of Adult Psychiatry, La Colombière Hospital, CHU Montpellier, Montpellier, France; University of Montpellier, Inserm U 1061, Montpellier, France
| | - Julien Dubreucq
- C3R - Réhabilitation Psychosociale et Remédiation Cognitive, Centre Hospitalier Alpes Isère, Grenoble, France
| | - Stéphane Raffard
- University Department of Adult Psychiatry, La Colombière Hospital, CHU Montpellier, Montpellier, France; Univ Paul Valéry Montpellier 3, Univ. Montpellier, EPSYLON EA 4556, 34000, Montpellier, France.
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5
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Opoka SM, Sundag J, Riehle M, Lincoln TM. Emotion-Regulation in Psychosis: Patients with Psychotic Disorders Apply Reappraisal Successfully. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10163-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract
Background
Emotion-regulation is assumed to be impaired in psychosis: patients with psychotic disorders (PD) self-report to use reappraisal less frequently than healthy controls (HC), but it is uncertain whether they are also less successful in applying reappraisal. Moreover, it has not been investigated whether the habitual use of reappraisal is associated with the ability to use reappraisal successfully.
Methods
To address these questions, PD (n = 60), a clinical control group of patients with anxiety disorders (AD; n = 40) and HC (n = 40) completed questionnaires on habitual emotion-regulation and alexithymia, performed tests on neurocognitive functioning and jumping-to-conclusion bias, and were subjected to an emotion-regulation paradigm, in which they were asked to down-regulate induced anxiety and sadness.
Results
No differences were found between PD and HC regarding the habitual use of reappraisal, but PD reported to use reappraisal more frequently than AD. All groups were able to down-regulate anxiety and sadness via reappraisal following instructions. The habitual use of reappraisal and the reduction of anxiety and sadness after instruction were uncorrelated.
Conclusion
These findings question the common assumption that PD use reappraisal less often or less successfully. At least under laboratory condition, PD do not appear to be impaired in reducing negative affect via reappraisal successfully.
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Pan DN, Hoid D, Wang ZH, Wang Y, Li X. Using questionnaires and task-related EEG signals to reveal hindered reappraisal and biased suppression in individuals with high schizotypal traits. Sci Rep 2020; 10:5529. [PMID: 32218454 PMCID: PMC7099017 DOI: 10.1038/s41598-020-62283-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 03/10/2020] [Indexed: 11/30/2022] Open
Abstract
Although impaired ability to regulate emotion is commonly reported in schizophrenic patients, the exact pattern of regulation of negative emotions in high-risk individuals remains unclear. In the current study, 26 high-schizotypy individuals paired with 26 controls completed an emotion regulation questionnaire (ERQ) and a laboratory emotion regulation task with electroencephalogram (EEG) recording. Two emotion regulation strategies, namely, reappraisal and expression suppression, were concurrently examined. The late positive potential (LPP) and frontal alpha asymmetry (FAA) were selected as two independent neural indicators of the emotion regulation effect. In the ERQ questionnaire, individuals in the high schizotypy group reported higher habitual use of suppression than the controls. During the emotion regulation task, the high schizotypy group showed no early LPP reduction in reappraisal compared with the control group and exhibited a general negative FAA pattern (left-biased alpha). In conclusion, we found that individuals with high schizotypy exhibited maladaptive regulation of negative emotions, manifested in hindered reappraisal and biased suppression; this may exacerbate the negative affect of such emotions and further serve as a risk factor for psychosis conversion. Early interventions targeting the regulation of negative emotions may be beneficial for individuals with high schizotypal traits.
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Affiliation(s)
- Dong-Ni Pan
- Key laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, 10049, China
| | - Delhii Hoid
- Key laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, 10049, China
| | - Zhen-Hao Wang
- Key laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, 10049, China
| | - Yi Wang
- Key laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, 10049, China
| | - Xuebing Li
- Key laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China.
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, 10049, China.
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7
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Perchtold CM, Weiss EM, Rominger C, Fink A, Weber H, Papousek I. Cognitive reappraisal capacity mediates the relationship between prefrontal recruitment during reappraisal of anger-eliciting events and paranoia-proneness. Brain Cogn 2019; 132:108-117. [PMID: 30980988 DOI: 10.1016/j.bandc.2019.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 03/26/2019] [Accepted: 04/02/2019] [Indexed: 01/19/2023]
Abstract
Difficulties in emotion regulation, particularly in using adaptive regulation strategies such as cognitive reappraisal, are a commonly observed correlate of paranoia. While it has been suggested that poor implementation of cognitive reappraisal in dealing with aversive events precedes the onset of subclinical paranoid thinking, there is little empirical research on neural activation patterns during cognitive reappraisal efforts that might indicate vulnerability towards paranoid thinking. Prefrontal EEG alpha asymmetry changes were recorded while n = 57 participants were generating alternative appraisals of anger-eliciting events, and were linked to a behavioral measure of basic cognitive reappraisal capacity and self-reported paranoia proneness (assessed by personality facets of hostility and suspiciousness; Personality Inventory for DSM-5). Mediation analysis revealed that less left-lateralized activation at ventrolateral prefrontal sites during reappraisal efforts predicted a higher degree of paranoia proneness. This relationship was mediated through poorer cognitive reappraisal capacity. Matching previous evidence, findings suggest that inappropriate brain activation during reappraisal efforts impairs individuals' capacity to come up with effective alternative interpretations for anger-evoking situations, which may accentuate personality features related to increased paranoid thinking. The findings add to our understanding of neurally underpinned impairments in the capacity to generate cognitive reappraisals and their link to maladaptive personality and behavior.
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Affiliation(s)
| | | | | | - Andreas Fink
- Department of Psychology, University of Graz, Austria.
| | - Hannelore Weber
- Department of Psychology, University of Greifswald, Germany.
| | - Ilona Papousek
- Department of Psychology, University of Graz, Austria. https://psychologie.uni-graz.at/en/biological-psychology/team/
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‘Twisting the lion's tail’: Manipulationist tests of causation for psychological mechanisms in the occurrence of delusions and hallucinations. Clin Psychol Rev 2019; 68:25-37. [DOI: 10.1016/j.cpr.2018.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 12/17/2018] [Accepted: 12/17/2018] [Indexed: 12/26/2022]
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9
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Opoka SM, Ludwig L, Lincoln TM. A Systematic Review of Trials Targeting Depression and Anxiety in Patients With Delusions. ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2018. [DOI: 10.1027/2151-2604/a000331] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Abstract. Negative affect and impaired emotion regulation skills are prevalent in patients with delusions and contribute to delusion formation and maintenance. This review evaluates existing research on interventions targeting negative affect and emotional processes as a causal mechanism on the pathway to delusions. A MEDLINE and PsycINFO search identified 7,909 articles. Five studies with randomized-controlled designs and three with uncontrolled designs met the inclusion criteria. Interventions comprised cognitive-behavioral and compassion-focused techniques. Overall, the review studies found positive intervention effects on negative affect and delusions. Where significant, controlled effect sizes ranged from small to large for negative affect and from moderate to large for delusions. Thus, existing research indicates that negative affect in patients with delusions can be modified by psychological therapy and points toward a carryover effect from the reduction of negative affect to a reduction of delusions. More large-scale randomized-controlled studies are needed to be able to draw valid conclusions on which types of interventions are most beneficial.
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Affiliation(s)
- Sandra M. Opoka
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, Germany
| | - Lea Ludwig
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, Germany
| | - Tania M. Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, Germany
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10
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Prochwicz K, Kłosowska J, Sznajder D. The role of expressive suppression in hallucinatory-like and delusion-like experiences. Findings in a non-clinical sample. Compr Psychiatry 2018; 82:121-127. [PMID: 29477704 DOI: 10.1016/j.comppsych.2018.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 02/01/2018] [Accepted: 02/02/2018] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Previous works concerning emotion regulation in psychosis highlighted the relationship between expressive suppression and negative psychotic symptoms, as well as between expressive suppression and auditory hallucinations. However, a direct association between suppression and delusions has not been observed. In the study we examined whether expressive suppression is associated with psychotic-like experiences and whether it may influence delusion-like experiences by changing the impact of cognitive biases on delusional beliefs. METHODS Two hundred and twenty-one healthy individuals never diagnosed with psychiatric disorders completed self-report questionnaires measuring: delusion-like experiences, hallucinatory-like experiences, cognitive biases and expressive suppression. Regression and moderation analyses were performed. RESULTS Regression analyses revealed that the overall level of suppression predicts hallucinatory-like experiences, but not delusion-like experiences. Suppression of anxiety and suppression of sadness were significant predictors of hallucinatory-like experiences, whereas suppression of anxiety predicted delusion-like experiences. A moderation analysis indicated that both the overall level of suppression and suppression of sadness moderate the relationship between belief inflexibility and delusion-like experiences in such a way that belief inflexibility increases delusion-like experiences only among individuals reporting a low level of suppression. CONCLUSIONS Our findings confirmed that expressive suppression has a direct impact on hallucinatory-like experiences and suggest that the use of suppression may influence delusion-like experiences by moderating the impact of belief inflexibility on delusional thinking.
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Affiliation(s)
| | - Joanna Kłosowska
- Jagiellonian University, Institute of Psychology, Krakow, Poland
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11
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Nittel CM, Lincoln TM, Lamster F, Leube D, Rief W, Kircher T, Mehl S. Expressive suppression is associated with state paranoia in psychosis: An experience sampling study on the association between adaptive and maladaptive emotion regulation strategies and paranoia. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2018; 57:291-312. [PMID: 29460461 DOI: 10.1111/bjc.12174] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 01/09/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Although emotional instability and problems in emotion regulation (ER) are known to be linked to the formation and maintenance of psychosis and paranoia, it remains unclear whether the use of specific ER strategies is associated with it. The first aim of the study was to explore the association between emotional instability and paranoia. The second and third aims were to investigate whether the use of maladaptive ER strategies leads to paranoia in patients with psychosis in daily life and whether the use of more adaptive ER strategies reduces paranoia. DESIGN A prospective momentary assessment study over the course of 6 days was performed. METHOD Participants with psychosis (n = 32) reported repeatedly over six consecutive days on the presence and instability of positive and negative emotions, their use of adaptive (reappraisal, acceptance, distraction, social sharing, reflection) and maladaptive ER strategies (rumination, expressive suppression) and momentary paranoia in their daily life. RESULTS Hierarchical linear regression analysis revealed that patients with psychosis who presented pronounced instability of negative emotions showed more severe levels of state paranoia. In addition, patients with psychosis who used expressive suppression when confronted with negative emotions at one point in time presented more pronounced levels of state paranoia at the following point in time. CONCLUSION The results presented here suggest that both emotional instability and the use of expressive suppression might cause state paranoia and thus add to our understanding of causal mechanisms related to paranoia such as instability of negative emotions and the use of less adaptive ER strategies. PRACTITIONER POINTS Maladaptive emotion regulation strategies and more pronounced instability of negative emotions are relevant to paranoia in patients with psychosis and should be a special focus of CBTp interventions. Future interventions designed for patients suffering from paranoia should promote coping with unstable negative emotions and replacing or reducing maladaptive emotion regulation strategies with adaptive ones.
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Affiliation(s)
- Clara Marie Nittel
- Department of Psychiatry and Psychotherapy, Marburg Center for Mind, Brain and Behavior, Philipps-University of Marburg, Germany.,Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Germany
| | - Tania Marie Lincoln
- Department of Clinical Psychology and Psychotherapy, University of Hamburg, Germany
| | - Fabian Lamster
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Germany.,Center for Acute Psychiatric Disorders, University Hospital of Psychiatry Zurich, Switzerland
| | - Dirk Leube
- AWO Center of Mental Health, Halle, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Marburg Center for Mind, Brain and Behavior, Philipps-University of Marburg, Germany
| | - Stephanie Mehl
- Department of Psychiatry and Psychotherapy, Marburg Center for Mind, Brain and Behavior, Philipps-University of Marburg, Germany.,Department of Health and Social Work, University of Applied Science, Frankfurt am Main, Germany
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12
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Shi J, Yao Y, Zhan C, Mao Z, Yin F, Zhao X. The Relationship Between Big Five Personality Traits and Psychotic Experience in a Large Non-clinical Youth Sample: The Mediating Role of Emotion Regulation. Front Psychiatry 2018; 9:648. [PMID: 30564151 PMCID: PMC6288374 DOI: 10.3389/fpsyt.2018.00648] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/16/2018] [Indexed: 11/13/2022] Open
Abstract
Objective: Despite a long history of interest in personality traits and psychosis, the association between personality traits and psychotic experiences in the general population is not yet well understood. One possible factor that could influence the degree of distress from psychotic experiences is emotion regulation. The purpose of this study was to explore whether the association between personality and psychotic symptoms is already apparent in non-clinical youth as well as the mediating role of emotion regulation strategies between personality traits and psychotic experiences. Methods: Three thousand one hundred and forty seven college students were surveyed via self-report questionnaires measuring the Five-Factor model of personality, emotion regulation strategies, and psychotic experiences. Results: Neuroticism was found to be significantly positively correlated with psychotic experiences, while Extraversion, Openness, Agreeableness, and Conscientiousness were found to be significantly negatively correlated. Both the suppression and reappraisal strategies mediated the relationship between personality traits and psychotic experiences. Conclusion: Our findings suggest that youth with certain personality traits are more likely to have psychotic experiences. The reappraisal emotion regulation strategy could serve as a protective factor against the distress of psychotic experiences.
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Affiliation(s)
- Jingyu Shi
- Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.,Division of Medical Humanities & Behavioral Sciences, Tongji University School of Medicine, Shanghai, China
| | - Yuhong Yao
- Students Counseling Center, Tongji University, Shanghai, China
| | - Chenyu Zhan
- Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ziyu Mao
- Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fang Yin
- Students Counseling Center, Tongji University, Shanghai, China
| | - Xudong Zhao
- Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.,Division of Medical Humanities & Behavioral Sciences, Tongji University School of Medicine, Shanghai, China
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13
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A structural equation model of the relationship between insomnia, negative affect, and paranoid thinking. PLoS One 2017; 12:e0186233. [PMID: 29049381 PMCID: PMC5648154 DOI: 10.1371/journal.pone.0186233] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 09/27/2017] [Indexed: 12/13/2022] Open
Abstract
Background A growing body of evidence points to relationships between insomnia, negative affect, and paranoid thinking. However, studies are needed to examine (i) whether negative affect mediates the relation between insomnia and paranoid thinking, (ii) whether different types of insomnia exert different effects on paranoia, and (iii) to compare the impact of objective and self-reported sleeping difficulties. Method Structural equation modelling was therefore used to test competing models of the relationships between self-reported insomnia, negative affect, and paranoia. n = 348 participants completed measures of insomnia, negative affect and paranoia. A subset of these participants (n = 91) went on to monitor their sleep objectively (using a portable sleep monitor made by Zeo) for seven consecutive nights. Associations between objectively recorded sleep, negative affect, and paranoia were explored using linear regression. Results The findings supported a fully mediated model where self-reported delayed sleep onset, but not self-reported problems with sleep maintenance or objective measures of sleep, was directly associated with negative affect that, in turn, was associated with paranoia. There was no evidence of a direct association between delayed sleep onset or sleep maintenance problems and paranoia. Conclusions Taken together, the findings point to an association between perceived (but not objective) difficulties initially falling asleep (but not maintaining sleep) and paranoid thinking; a relationship that is fully mediated by negative affect. Future research should seek to disentangle the causal relationships between sleep, negative affect, and paranoia (e.g., by examining the effect of an intervention using prospective designs that incorporate experience sampling). Indeed, interventions might profitably target (i) perceived sleep quality, (ii) sleep onset, and / or (iii) emotion regulation as a route to reducing negative affect and, thus, paranoid thinking.
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Abstract
Many individuals in the general population experience psychotic-like experiences in the absence of a psychotic disorder. The degree of psychological distress associated with these experiences is a key predictor of clinical outcomes. One factor that may influence the degree of distress from psychotic-like experiences is emotion regulation. Although it has been demonstrated that emotion regulation deficits are present in psychotic disorders, the association between emotion regulation and subclinical psychotic-like experiences is not well understood. Here, we examined the associations between frequency of and distress from psychotic-like experiences and several key components of emotion regulation: difficulties with emotion regulation; emotion regulation self-efficacy; and emotion regulation strategy use. Difficulties with emotion regulation and maladaptive patterns of emotion regulation strategy use were associated with the frequency of both positive and negative psychotic-like experiences. In addition, results suggest that habitual acceptance use and reappraisal self-efficacy may serve as protective factors against the distress associated with psychotic-like experiences.
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Laloyaux J, Dessart G, Van der Linden M, Lemaire M, Larøi F. Maladaptive emotion regulation strategies and stress sensitivity mediate the relation between adverse life events and attenuated positive psychotic symptoms. Cogn Neuropsychiatry 2016; 21:116-29. [PMID: 26829655 DOI: 10.1080/13546805.2015.1137213] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION There is now solid evidence for a relation between adverse life events (ALE) and psychotic symptoms in patients with psychosis and in the general population. A recent study has shown that this relation may be partially mediated by stress sensitivity, suggesting the influence of other factors. The aim of this study was to assess the mediation effect of emotion regulation strategies and stress sensitivity in the relation between ALE and attenuated positive psychotic symptoms (APPS) in the general population. METHODS Hundred and twelve healthy volunteers were evaluated with measures of APPS, emotion regulation strategies, ALE and stress sensitivity. RESULTS Results demonstrated that the relation between ALE, hallucination and delusion proneness was completely mediated by maladaptive emotion regulation strategies, but not by stress sensitivity. However, in addition to maladaptive emotion regulation strategies, stress sensitivity demonstrated a mediation effect between ALE and attenuated positive psychotic positive symptoms when positive psychotic symptoms were grouped together. CONCLUSIONS There are probably several possible trajectories leading to the formation of positive psychotic symptoms and the results of the present study reveal that one such trajectory may involve the maladaptive regulation of negative emotions alongside a certain general vulnerability after experiencing ALE.
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Affiliation(s)
- Julien Laloyaux
- a Department of Psychology , University of Liège , Liège , Belgium
| | - Grégory Dessart
- b Faculty of Theology and Religious Studies , Institute for Social Sciences of Contemporary Religions, University of Lausanne , Lausanne , Switzerland
| | - Martial Van der Linden
- a Department of Psychology , University of Liège , Liège , Belgium.,c Cognitive Psychopathology and Neuropsychology Unit , University of Geneva , Geneva , Switzerland
| | - Morgan Lemaire
- a Department of Psychology , University of Liège , Liège , Belgium
| | - Frank Larøi
- a Department of Psychology , University of Liège , Liège , Belgium.,d Department of Biological and Medical Psychology , University of Bergen , Bergen , Norway
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Dysfunctional coping with stress in psychosis. An investigation with the Maladaptive and Adaptive Coping Styles (MAX) questionnaire. Schizophr Res 2016; 175:129-135. [PMID: 27210727 DOI: 10.1016/j.schres.2016.04.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/07/2016] [Accepted: 04/18/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Psychotic episodes have long been conceptualized as inevitable incidents triggered by endogenous biological impairments. It is now well-accepted that the ability of an individual to deal with social and environmental challenges plays an important role in regard to whether or not a vulnerability to psychosis translates into symptoms. For the present study, we examined symptomatic correlates of dysfunctional coping in psychosis and aimed to elucidate a profile of coping strategies that distinguishes patients with schizophrenia from those with depression. METHOD The newly devised Maladaptive and Adaptive Coping Styles Scale (MAX) was administered to 75 individuals with psychosis, 100 individuals with depression and 1100 nonclinical controls. RESULTS Schizophrenia patients showed compromised coping abilities relative to nonclinical controls, particularly a lack of engaging in adaptive coping. Depression was more closely tied to dysfunctional coping than were positive symptoms as indicated by group comparisons and correlational analyses. Correlations between positive symptoms, particularly paranoid symptoms, and avoidance and suppression remained significant when depression was controlled for. CONCLUSIONS Although maladaptive and adaptive coping are unlikely to represent proximal mechanisms for the pathogenesis of positive symptoms, fostering coping skills may reduce positive symptoms via the improvement of depressive symptoms, which are increasingly regarded as risk factors for core psychotic symptoms. Furthermore, the reduction of avoidance and suppression may directly improve positive symptoms.
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Park JS, Kang UG. How delusion is formed? Med Hypotheses 2016; 87:61-5. [PMID: 26826642 DOI: 10.1016/j.mehy.2015.12.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 12/14/2015] [Accepted: 12/19/2015] [Indexed: 10/22/2022]
Abstract
Traditionally, delusions have been considered to be the products of misinterpretation and irrationality. However, some theorists have argued that delusions are normal or rational cognitive responses to abnormal experiences. That is, when a recently experienced peculiar event is more plausibly explained by an extraordinary hypothesis, confidence in the veracity of this extraordinary explanation is reinforced. As the number of such experiences, driven by the primary disease process in the perceptual domain, increases, this confidence builds and solidifies, forming a delusion. We tried to understand the formation of delusions using a simulation based on Bayesian inference. We found that (1) even if a delusional explanation is only marginally more plausible than a non-delusional one, the repetition of the same experience results in a firm belief in the delusion. (2) The same process explains the systematization of delusions. (3) If the perceived plausibility of the explanation is not consistent but varies over time, the development of a delusion is delayed. Additionally, this model may explain why delusions are not corrected by persuasion or rational explanation. This Bayesian inference perspective can be considered a way to understand delusions in terms of rational human heuristics. However, such experiences of "rationality" can lead to irrational conclusions, depending on the characteristics of the subject.
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Affiliation(s)
- Jong Suk Park
- Department of Psychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea; Department of Psychiatry, Maeumsarang Hospital, Wanju, Jeollabuk-do, Republic of Korea
| | - Ung Gu Kang
- Department of Psychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea; Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Republic of Korea; Institute of Human Behavioral Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Republic of Korea.
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Hesse K, Kriston L, Mehl S, Wittorf A, Wiedemann W, Wölwer W, Klingberg S. The Vicious Cycle of Family Atmosphere, Interpersonal Self-concepts, and Paranoia in Schizophrenia-A Longitudinal Study. Schizophr Bull 2015; 41:1403-12. [PMID: 25925392 PMCID: PMC4601709 DOI: 10.1093/schbul/sbv055] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Recent cognitive models of paranoid delusions highlight the role of self-concepts in the development and maintenance of paranoia. Evidence is growing that especially interpersonal self-concepts are relevant in the genesis of paranoia. In addition, negative interpersonal life-experiences are supposed to influence the course of paranoia. As dysfunctional family atmosphere corresponds with multiple distressing dyadic experiences, it could be a risk factor for the development and maintenance of paranoia. A total of 160 patients with a diagnosis of schizophrenia were assessed twice within 12 months. Standardized questionnaires and symptom rating scales were used to measure interpersonal self-concepts, perceived family atmosphere, and paranoia. Data were analyzed using longitudinal cross-lagged structural equation models. Perceived negative family atmosphere was associated with the development of more pronounced negative interpersonal self-concepts 12 months later. Moreover, paranoia was related to negative family atmosphere after 12 months as well. As tests revealed that reversed associations were not able to explain the data, we found evidence for a vicious cycle between paranoia, family atmosphere, and interpersonal self-concepts as suggested by theoretical/cognitive model of paranoid delusions. Results suggest that broader interventions for patients and their caretakers that aim at improving family atmosphere might also be able to improve negative self-concepts and paranoia.
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Affiliation(s)
- Klaus Hesse
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany;
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stephanie Mehl
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Andreas Wittorf
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Wolfgang Wiedemann
- Department of Psychiatry and Psychotherapy, Klinikum-Fulda, Fulda, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty University of Düsseldorf, Germany
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
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Evidence of Contrasting Patterns for Suppression and Reappraisal Emotion Regulation Strategies in Alexithymia. J Nerv Ment Dis 2015; 203:709-17. [PMID: 26252826 DOI: 10.1097/nmd.0000000000000353] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Alexithymia generally refers to difficulties in identifying and describing emotions. In this paper, two studies explored whether the emotion deficits observed in alexithymia may be related to the use of emotion regulation strategies. Relations with various sociodemographic variables were also explored. In the first study, 255 students completed the Emotion Regulation Questionnaire (ERQ) and the Toronto Alexithymia Scale-20. For the second study, 1107 participants from the general population completed the ERQ and the Bermond-Vorst Alexithymia Questionnaire. Results demonstrated that alexithymia was related to the use of a suppression strategy and in particular to difficulties verbalizing emotions, suggesting that the capacity to communicate and name one's emotion is a central aspect in alexithymia. Concerning sociodemographic variables, alexithymia and the use of a suppression strategy were found to be related to age and to be higher in males. The results of these studies and their clinical implications for treatment are discussed.
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Garety P, Waller H, Emsley R, Jolley S, Kuipers E, Bebbington P, Dunn G, Fowler D, Hardy A, Freeman D. Cognitive mechanisms of change in delusions: an experimental investigation targeting reasoning to effect change in paranoia. Schizophr Bull 2015; 41:400-10. [PMID: 25053650 PMCID: PMC4332945 DOI: 10.1093/schbul/sbu103] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Given the evidence that reasoning biases contribute to delusional persistence and change, several research groups have made systematic efforts to modify them. The current experiment tested the hypothesis that targeting reasoning biases would result in change in delusions. METHODS One hundred and one participants with current delusions and schizophrenia spectrum psychosis were randomly allocated to a brief computerized reasoning training intervention or to a control condition involving computer-based activities of similar duration. The primary hypotheses tested were that the reasoning training intervention, would improve (1) data gathering and belief flexibility and (2) delusional thinking, specifically paranoia. We then tested whether the changes in paranoia were mediated by changes in data gathering and flexibility, and whether working memory and negative symptoms moderated any intervention effects. RESULTS On an intention-to-treat analysis, there were significant improvements in state paranoia and reasoning in the experimental compared with the control condition. There was evidence that changes in reasoning mediated changes in paranoia, although this effect fell just outside the conventional level of significance after adjustment for baseline confounders. Working memory and negative symptoms significantly moderated the effects of the intervention on reasoning. CONCLUSION The study demonstrated the effectiveness of a brief reasoning intervention in improving both reasoning processes and paranoia. It thereby provides proof-of-concept evidence that reasoning is a promising intermediary target in interventions to ameliorate delusions, and thus supports the value of developing this approach as a longer therapeutic intervention.
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Affiliation(s)
- Philippa Garety
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK;
| | - Helen Waller
- Department of Psychology, Institute of Psychiatry, King’s College London, London, UK
| | - Richard Emsley
- Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Suzanne Jolley
- Department of Psychology, Institute of Psychiatry, King’s College London, London, UK
| | - Elizabeth Kuipers
- Department of Psychology, Institute of Psychiatry, King’s College London, London, UK
| | - Paul Bebbington
- Mental Health Sciences Unit, Faculty of Brain Sciences, University College London, London, UK
| | - Graham Dunn
- Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - David Fowler
- Department of Psychology, University of Sussex, Brighton, UK
| | - Amy Hardy
- Department of Psychology, Institute of Psychiatry, King’s College London, London, UK
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Westermann S, Boden MT, Gross JJ, Lincoln TM. Maladaptive Cognitive Emotion Regulation Prospectively Predicts Subclinical Paranoia. COGNITIVE THERAPY AND RESEARCH 2013. [DOI: 10.1007/s10608-013-9523-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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