Self‐reported emotion regulation difficulties in people with psychosis compared with non‐clinical controls: A systematic literature review

Abstract

Emotions play a key role in the development and experience of psychosis, yet there are important gaps in our understanding of how individuals with psychosis understand and respond to their emotions. This systematic review investigated self‐reported emotion regulation difficulties in individuals with psychosis compared with non‐clinical controls. An electronic database search was conducted in Medline, PsychINFO, and Embase and supplemented by searches of reference lists and citations. Seventeen studies were included. A narrative synthesis was conducted because contextual diversity was present across the studies and outcomes. Individuals with psychosis reported greater difficulties in (i) emotional clarity (specifically with identifying, describing, and understanding their emotions), (ii) emotional acceptance, (iii) engaging in goal‐directed behaviours when experiencing negative emotions, and (iv) willingness to experience emotional distress in the pursuit of meaningful activities in life. Evidence pertaining to other self‐reported emotion regulation difficulties was less clear. Effect sizes were generally large in magnitude but there were few studies on some self‐reported emotion regulation difficulties, and all studies were at moderate to high risk of bias. Further research is needed to clarify the nature of emotion regulation difficulties in individuals with psychosis to inform the provision of targeted clinical interventions.

Self‐reported emotion regulation difficulties in psychosis: Psychometric properties of the Difficulties in Emotion Regulation Scale (DERS‐16)

“…Most research has focused on the habitual use of ER strategies and found that psychosis is associated with greater self‐reported use of more putatively maladaptive strategies (e.g., rumination) and less frequent use of a more efficacious strategy (cognitive reappraisal) compared to nonclinical controls, although there has been considerable heterogeneity of results (see Ludwig et al, 2019 for a review and meta‐analysis). Difficulties in understanding, relating and responding to emotions have received less research attention; however, research to date has found that individuals with psychosis report difficulties in relation to identifying, understanding, and accepting their emotions, engaging in goal‐directed behavior, and willingness to experience negative emotions in the pursuit of meaningful activities compared to nonclinical controls (Lawlor et al, 2020). Laboratory‐based and experience sampling method studies further indicate difficulties in tolerating distress (Chiappelli et al, 2014; Nugent et al, 2014) and in successfully identifying, selecting, and implementing ER strategies to reduce negative emotion unless individuals are instructed to do so (Horan et al, 2013; Painter et al, 2019; Perry et al, 2012; Strauss et al, 2013, 2019; Visser et al, 2018).…”

“…Furthermore, individuals' personal accounts of their experiences of psychosis emphasize that support to deal with negative emotions and feeling less overwhelmed by emotions are important and sometimes neglected foci of psychological therapy (Greenwood et al, 2010; Griffiths et al, 2019; Holding et al, 2016; Hutchins et al, 2016; Lawlor et al, 2017). Taken together these findings suggest that further research and clinical attention is warranted however, while there are adequate measures of ER strategy use in psychosis (Ludwig et al, 2019), assessing and clinically targeting ER difficulties has been hindered by the lack of comprehensive and psychometrically sound measures for use with individuals with psychosis (Lawlor et al, 2020).…”

Versión en Español del Emotion Regulation Skills Questionnaire: Análisis de su Fiabilidad y Validez

“…Por otra parte, el ERSQ ha sido empleado para investigar la regulación emocional tanto en población en general como en población clínica permitiendo identificar importantes diferencias. De esta manera, ha sido posible documentar los efectos de la regulación emocional en una gran variedad de procesos psicológicos entre los que destacan el trastorno de déficit de atención e hiperactividad y el trastorno límite de la personalidad (Cavelti et al, 2019), psicosis (Lawlor et al, 2020), depresión y ansiedad (Lukas et al, 2018), calidad de vida y rasgos de personalidad (Pocnet et al, 2017), apego (Owens et al, 2018), pérdida de control e impotencia (Berking et al, 2010), imagen corporal (Shriver et al, 2021, violencia de pareja (Berke et al, 2019), entre otros.…”

Maladaptive cognitive emotion regulation strategies and positive symptoms in schizophrenia spectrum disorders: The mediating role of global emotion dysregulation

“…Poor regulatory flexibility is suggested to account for why some individuals are observed to have a greater tendency to rely on a narrow set of cognitive emotion regulation strategies (e.g., worry and rumination) to cope, which could increase the risk for psychopathology. Corroborating evidence shows that patients with schizophrenia spectrum disorders have poorer emotion regulation and metacognitive abilities, and these may be linked to the habitual use of worry, rumination, and expressive suppression within this population (Lawlor, Hepworth, Smallwood, Carter, & Jolley, 2019; van Camp, Sabbe, & Oldenburg, 2017). Accordingly, the habitual use of these strategies and their association with more severe positive symptoms highlight their maladaptive nature (Liu, Chua, Chong, Subramaniam, & Mahendran, 2020).…”

“…Although global emotion dysregulation may overlap with maladaptive cognitive emotion regulation strategies, there is conceptual and empirical evidence to support the view that both constructs are distinct (Lawlor et al, 2019; Naragon‐Gainey, McMahon, & Chacko, 2017). From a conceptual perspective, global emotion dysregulation refers to a broad deficit in overall emotion regulation and emotional functioning, which is theoretically distinct from a strategy‐based conceptualization of emotion dysregulation (Bardeen & Fergus, 2014; Sloan et al, 2017).…”