Beyond “Cold” Cognition: Exploring Cognitive Control of Emotion as a Risk Factor for Psychosis


The past 20 years of research examining psychosis risk factors has predominantly focused on “cold” cognitive (i.e., non-affective) processes. Despite identification of potential cognitive and associated brain-based vulnerability markers, our ability to identify those individuals at highest risk for future psychosis has not substantially improved. Consequently, researchers have begun to examine emotion-processing deficits as potential psychosis vulnerability markers. Here we propose that a particular emotion-processing domain, cognitive control of emotion, is a potential transdiagnostic mechanism underlying the heterogeneity of clinical presentation and psychosocial impairments observed in high-risk populations. Recent investigations indicate impaired cognitive control of emotion is observable across the psychosis spectrum and relates to important clinical and psychosocial outcomes relevant to the high-risk state. Moreover, preliminary evidence indicates treatment interventions aimed at improving cognitive control of emotion could reduce psychotic symptoms and improve functioning. We highlight gaps in current knowledge and propose five key avenues for future investigations.