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

Abstract

Emotion regulation (ER) difficulties are ubiquitous among individuals with schizophrenia and have been hypothesized to contribute to stress sensitivity and exacerbation of psychotic symptoms in this population. However, the evidence supporting this link is equivocal, potentially due to previous studies' reliance on retrospective assessments of ER and psychosis, as well as lack of consideration of putative moderators such as emotion awareness. To address these limitations, we employed experience sampling method using mobile electronic devices to investigate the links between momentary in vivo use of ER strategies (m ER), emotion awareness, and psychotic symptoms during daily functioning. Fifty-four individuals with schizophrenia completed assessment of m ER and psychotic symptoms, along with traditional retrospective measures of ER and symptoms. Use of m ER suppression predicted significant increases in momentary experiences of thought insertion, mind reading, auditory and visual hallucinations. Use of m ER reappraisal predicted significant increases in momentary experiences of suspiciousness, thought insertion, and mind reading. Emotion awareness, driven primarily by difficulties identifying feelings, moderated the impact of ER on psychotic symptoms. There were no associations between retrospective measures of ER and symptoms. Our results indicate that, among individuals with schizophrenia, emotion awareness significantly impacts the relationship between use of ER and exacerbations in psychotic symptoms during the course of daily functioning. Our results highlight the need to incorporate emotion awareness and regulation difficulties into the development of treatment models and interventions for psychosis. In addition, our results underscore the need to employ in vivo, high time-resolution assessment methods to study dynamic clinical phenomena such as ER and psychotic symptoms.

Looking within: Interoceptive sensibility in young adults with psychotic‐like experiences

“…Our results are in line with previous evidence of greater attention to emotions in healthy individual with schizotypal personality (Kerns, 2005). On the other hand, reduced emotional awareness is typically observed in individuals at clinical high-risk for psychosis (e.g., van Rijn et al, 2011) and among psychotic patients (e.g., Kimhy et al, 2012Kimhy et al, , 2020. This suggests that these deficits could be specific to individuals with clinicallyrelevant manifestations of psychosis.…”

Are Acute Increases and Variability in Emotion Regulation Strategies Related to Negative Affect and Paranoid Thoughts in Daily Life?

“…Reappraisal is commonly considered a functional emotion regulation strategy (Webb et al, 2012), but recently it was discussed that its use is not always beneficial (Ford & Troy, 2019). Some studies have even found reappraisal to be associated with more pronounced paranoid thoughts (Kimhy et al, 2020;Westermann et al, 2012) and to increase negative affect during psychotic experiences (Strauss et al, 2019). For determining the functionality of reappraisal, the reappraised thought contents and the context, in which it is used, may need to be considered.…”

Alexithymia Is a Key Mediator of the Relationship Between Magical Thinking and Empathy

“…We also included the Emotion Contagion Scale ( 28 ) to look at mirroring or emotional resonance with others. Furthermore, we included the Toronto Alexithymia Scale ( 29 , 30 ), as alexithymia (i.e., difficulties with identifying and describing internal emotional states) may in turn influence social cognition ( 31 ) and can be seen in disorders associated with magical thinking [OCD ( 16 , 32 , 33 ); schizophrenia ( 34 , 35 )]. In order to explore which factors may mediate the relationship between TAF and empathy, we included a couple of other scales relevant to conditions such as OCD and schizophrenia that are likely to be related to magical thinking.…”