Emotion dysregulation mediates the relationship between nightmares and psychotic experiences: results from a student population

Abstract

Sleep disruption is commonly associated with psychotic experiences. While sparse, the literature to date highlights nightmares and related distress as prominent risk factors for psychosis in students. We aimed to further explore the relationship between specific nightmare symptoms and psychotic experiences in university students while examining the mediating role of emotion dysregulation. A sample (N = 1273) of student respondents from UK universities completed measures of psychotic experiences, nightmare disorder symptomology and emotion dysregulation. Psychotic experiences were significantly more prevalent in students reporting nightmares (n = 757) relative to those who did not (n = 516). Hierarchical linear regression analysis showed that psychotic experiences were significantly associated (Adjusted R 2 = 32.4%) with perceived nightmare intensity, consequences and resulting awakenings, and with emotion regulation difficulties. Furthermore, multiple mediation analysis showed that the association between psychotic experiences and nightmare factors was mediated by emotion regulation difficulties. Adaptive regulation of dream content during rapid eye-movement sleep has previously been demonstrated to attenuate surges in affective arousal by controlling the intensity and variability of emotional content. Difficulties in emotion regulation may partially explain the experience of more intense and disruptive nightmares among individuals with psychotic experiences. Emotion regulation may represent an important control mechanism that safeguards dream content and sleep quality.

A Latent Profile Analysis of Psychotic Experiences, Non-psychotic Symptoms, Suicidal Ideation and Underlying Mechanisms in a Sample of Adolescents From the General Population

“…Thus, the prominent presence of emotional suppression in this class could be a potential process increasing the distress experienced by individuals with high levels of psychopathological symptoms. This is in line with previous findings showing that it is a maladaptive strategy associated with psychotic symptoms ( 44 , 47 ) and that emotional regulation difficulties play a translating role from childhood trauma into distressing PEs in later life ( 43 ).…”

“…Specifically, it has been shown that adolescents endorsing PEs use more emotional suppression and less cognitive reappraisal ( 45 ), which is in turn associated with higher comorbid symptomatology ( 46 ). However, the evidence of emotional difficulties in psychotic disorders remains mixed ( 25 , 47 ).…”

Evaluating the Factor Structure of the Emotion Dysregulation Scale-Short (EDS-s): A Preliminary Study

“…There is an overall consensus about considering ED as a transdiagnostic feature characterizing several disorders [ 3 ]. For example, deficits in emotion regulation have been reported in several conditions, including eating disorders [ 4 ], mood and anxiety disorders [ 5 ], sleep disorders [ 6 ], psychotic disorders [ 7 ], personality disorders [ 8 ], and dissociative disorders [ 9 ].…”

Inhibitory Learning as Prediction Error Feedback Loop

“…In the salience network (SN), CBGTC circuits are postulated to formulate a mechanism for the development and treatment of many psychiatric conditions (Peters, Dunlop, & Downar, 2016). These circuits play a role in disorders such as addiction, schizophrenia, OCD, PTSD, chronic pain, depression, anhedonia, and suicide (Cisler et al, 2018;Gradin et al, 2011;Maia & Frank, 2011;Ploner, Sorg, & Gross, 2017;Schmaal et al, 2019;Shin & Liberzon, 2009;Ubl et al, 2015), which share emotion dysregulation as an etiological and/or maintenance factor (Akram et al, 2020;Der-Avakian & Markou, 2012;Dvir, Ford, Hill, & Frazier, 2014;Eskelund, Karstoft, & Andersen, 2018;Garfield, Lubman, & Yücel, 2014;Riquino, Priddy, Howard, & Garland, 2018;Winer et al, 2017). Thus, abnormalities in CBGTC circuits and prediction errors are not only associated with mental health problems characterized by a lack of cognitive control over maladaptive thoughts, impulsive behaviors, and inattention to relevant internal and external stimuli (Peters et al, 2016), but these circuits may also be relevant to the treatment of disorders which share emotion dysregulation more generally as an etiological and/or maintenance factor.…”