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

Abstract

Objectives Accumulating research evidence supports the role of emotion dysregulation in the etiology of schizophrenia spectrum disorders. The present systematic review synthesized the extant literature and aimed to determine the effects of cognitive emotion regulation strategies and global emotion dysregulation on positive and negative symptoms in schizophrenia spectrum disorders. Method A comprehensive systematic review was conducted to identify quantitative studies published between 2000 and 2019. A total of 22 studies were included in this review. Results Overall, maladaptive cognitive emotion regulation strategies of rumination, worry, and suppression were generally related to more positive symptoms, while global emotion dysregulation was related to more positive and negative symptoms. Conclusions Our results provide preliminary and conceptual evidence on the role of emotion dysregulation in understanding schizophrenia spectrum disorders. Psychological treatment should further determine the therapeutic value of addressing emotion dysregulation to improve positive and negative symptoms in schizophrenia spectrum disorders.

Elucidating the Impact of Childhood, Adulthood, and Cumulative Lifetime Trauma Exposure on Psychiatric Symptoms in Early Schizophrenia Spectrum Disorders

“…Previous studies have indicated overlaps between positive symptoms of schizophrenia and depressive and anxiety symptoms and suggested that difficulties in regulating negative affect could link these symptoms together. One piece of evidence supporting this view is the role of emotion dysregulation in exacerbating positive symptoms of schizophrenia and depressive and anxiety symptoms in schizophrenia spectrum disorders (Liu et al., 2020; Upthegrove et al., 2017). Among trauma‐exposed patients with schizophrenia spectrum disorders, difficulties in regulating negative emotions, such as fear, anger, and guilt, in response to severe traumatic stress may trigger, maintain, and exacerbate positive symptoms of schizophrenia, depressive symptoms, and anxiety symptoms.…”

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

“…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 strategybased conceptualization of emotion dysregulation (Bardeen & Fergus, 2014;Sloan et al, 2017). Preliminary research has revealed that global emotion dysregulation is associated with more severe positive and negative symptoms in schizophrenia spectrum disorders (Liu et al, 2020;Owens, Haddock, & Berry, 2013). Whereas such studies demonstrate the direct association between global emotion dysregulation and positive symptoms, no study has determined the mediating or moderating role of global emotion dysregulation in the relationship between maladaptive cognitive emotion regulation strategies and positive symptoms.…”

“…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).…”

“…Preliminary research has revealed that global emotion dysregulation is associated with more severe positive and negative symptoms in schizophrenia spectrum disorders (Liu et al, 2020; Owens, Haddock, & Berry, 2013). Whereas such studies demonstrate the direct association between global emotion dysregulation and positive symptoms, no study has determined the mediating or moderating role of global emotion dysregulation in the relationship between maladaptive cognitive emotion regulation strategies and positive symptoms.…”

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

“…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). Importantly, self‐reported ER difficulties are associated with a range of negative outcomes including more severe psychotic experiences (e.g., D'Antonio et al, 2015; Gawęda & Krężołek, 2019; Liu, Chua, et al, 2020; Serper & Berenbaum, 2008), increased psychological distress and reduced emotional well‐being (Moran et al, 2018; Perry et al, 2011; van der Meer et al, 2009) and poorer social functioning (e.g., Kimhy et al, 2012, 2014) and have been found to mediate and moderate the association between ER strategy use and psychotic symptoms (Kimhy et al, 2020; Lui, Subramaniam, et al, 2020). 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).…”