Emotion-Regulation in Psychosis: Patients with Psychotic Disorders Apply Reappraisal Successfully

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.

Educational Response to a Student with Psychosis at the Secondary Level: A Non-Experimental Single-Case Study

“…It is worth noting that the levels found in alexithymia in our research were higher than in the normal population; similarly, the subject’s enjoyment of life was lower than in the population, but relatively similar to the clinical sample in a previous study [ 29 ]. It is inferred that students with psychosis will obtain high levels of alexithymia in line with previous studies [ 15 , 41 , 42 ].…”

“…The test reached a Cronbach's alpha consistency index of 0.078 [28]. -Savoring Beliefs Inventory (SBI), Spanish version of [29] of the original scale of [30] It consists of 24 items expressed by means of a Likert-type scale that goes from 0 = Nothing to 4 = A lot or Extremely, distributed in three factors: "Anticipation" refers to the ability to be able to visualize a pleasant event or situation before it happens and is composed of items 1, 4, 7, 9, 10, and 13 (e.g., "I don't like to think in advance about good times before they happen"); "Enjoy a present moment" is the capacity to be able to find pleasure in carrying out an activity at present and is composed of items 2, 3,5,11,15,17,18,19,21, and 23 (e.g., "I enjoy remembering the happy moments I have experienced in my past"); and "Reminiscence" which is the ability to be able to evoke a positive event that has happened before, being composed of items 6, 8, 10, 12, 14, 16, 20, 22, and 24 (e.g., "When it comes to enjoyment I am "my worst enemy"). The overall internal consistency measured through Cronbach's alpha was 0.91.…”

“…One of the closely related concepts of emotional adjustment is alexithymia, which consists of the inability to manage emotions, to recognize one’s own emotional expressions and those of others, so that people with high levels of alexithymia have greater difficulties in relationships. People with psychosis have difficulties in the emotional sphere and may have high levels of alexithymia [ 15 ].…”

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

“…A recent meta-analysis of questionnaire studies examining the frequency of strategies showed that individuals with psychosis typically report to use more dysfunctional and less functional strategies than healthy controls (Ludwig et al, 2019b). In contrast to the consistent picture presented by these studies, experimental studies that commonly induce affect along with the instruction to use a certain emotion regulation strategy tend to find that individuals with psychosis are as successful as healthy controls in effectively down-regulating their negative affect (Grezellschak et al, 2015;Opoka et al, 2020Opoka et al, , 2021Perry et al, 2012;Van Meer et al, 2014). Putative reasons for the discrepancy between the findings in questionnaire and experimental studies are a retrospective recall bias in the questionnaire studies and the artificialness of the instructions in the experimental design and the induced emotion, which questions their ecological validity.…”

Thought Suppression in Primary Psychotic Disorders and Substance/Medication Induced Psychotic Disorder

“…Patients with psychosis may use thought suppression as a cognitive coping strategy (e.g., to reduce the distress associated with the delusions and/or auditory hallucinations); however, as stated earlier, with a potential rebound effect [ 21 ]. There is evidence that psychotic patients also use cognitive reappraisal frequently to reduce negative emotions, such as anxiety or depression [ 22 ]. However, research indicates that there is a preference for suppression over cognitive reappraisal among psychotic patients who experience positive symptoms [ 23 ].…”