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

Abstract

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.

The impact of emotion dysregulation on positive and negative symptoms in schizophrenia spectrum disorders: A systematic review

“…There were mixed findings among the cross‐sectional studies with some studies finding a negative relationship between cognitive reappraisal and positive symptoms ( r = −.40, p < .01; N = 46 outpatients; Grezellschak, Jansen, & Westermann, 2017) or negative symptoms ( r = −.48, p = .05; N = 33 outpatients; Perry et al, 2011), while others did not observe any relationships (Badcock et al, 2011; Henry, Rendell, Green, McDonald, & O'Donnell, 2008; Moran, Culbreth, & Barch, 2018). There was only one experimental sampling method study ( N = 32 outpatients), which observed an unexpected positive relationship between cognitive reappraisal and state paranoia ( r = .29, p < .01; Nittel et al, 2018). However, the same study did not observe a significant relationship between cognitive reappraisal and paranoia symptoms over time (Nittel et al, 2018).…”

“…There was only one experimental sampling method study ( N = 32 outpatients), which observed an unexpected positive relationship between cognitive reappraisal and state paranoia ( r = .29, p < .01; Nittel et al, 2018). However, the same study did not observe a significant relationship between cognitive reappraisal and paranoia symptoms over time (Nittel et al, 2018). In summary, more prospective research is needed to clarify the relationships between cognitive reappraisal and positive and/or negative symptoms.…”

“…There was low to moderate heterogeneity among included studies ( I 2 = 46.9%). In terms of examining causality, one experimental sampling method study ( N = 32 outpatients) found that expressive suppression at the previous report predicted more paranoia symptoms over time, after controlling for negative emotions and state paranoia at the previous report (Nittel et al, 2018). In summary, there is preliminary evidence to show that expressive suppression is positively associated with positive symptoms.…”

“…A previous synthesis of the literature has revealed that patients with schizophrenia used more maladaptive and less adaptive cognitive emotion regulation strategies than healthy controls (O'Driscoll et al, 2014). Current findings also generally show that maladaptive cognitive emotion regulation strategies are positively related to positive symptoms (Nittel et al, 2018). This is supported by cognitive models of psychosis, which posit that the habitual use of maladaptive cognitive emotion regulation strategies may increase the tendency for cognitive biases and misinterpretations of negative affective states, and these, in turn, may increase the risk of hallucinations and delusions (Garety & Freeman, 2013).…”

“…Experimental assessments of worry and rumination are also found to be valid among patients with schizophrenia spectrum disorders (Ricarte et al, 2018; Startup, Freeman, & Garety, 2007). To address potential context biases, a recent experimental sampling method study ( N = 32 outpatients with schizophrenia spectrum disorders) examined a range of cognitive emotion regulation strategies in relation to symptoms of paranoia over a course of 6 days (Nittel et al, 2018). It was found that only expressive suppression predicted more symptoms of paranoia over time ( b = 0.03, standard error [ SE ] = 0.02, p < .05; Nittel et al, 2018).…”