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Deconstructing emotion regulation in schizophrenia: the nature and consequences of abnormalities at the identification stage

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Abstract

Existing evidence suggests that emotion regulation is abnormal in schizophrenia and associated with undesirable clinical outcomes. However, this literature is based predominantly on trait self-report and does not indicate which stages of emotion regulation (identification, selection, implementation) are impaired. The current study focused on determining the nature of abnormalities at the identification stage using ecological momentary assessment (EMA). Participants included clinically stable outpatients with schizophrenia (SZ; n = 48) and healthy controls (CN; n = 52) who completed 6 days of EMA. The EMA surveys assessed emotional experience, emotion regulation, and symptoms. Results indicated that SZ identified the need to regulate at a higher rate than CN. Specifically, SZ displayed an inefficient threshold for identifying the need to regulate, such that they regulated too much when negative affect was low and too little when negative affect was high. Emotion regulation effort exertion was also inefficient, such that effort was too high at low levels of negative affect and too low at high levels of negative affect in SZ. These identification stage abnormalities also demonstrated differential associations with positive and negative symptoms. Findings suggest that identification stage abnormalities may create a bottleneck that feeds forward and impacts subsequent stages of emotion regulation in SZ that are critically related to symptoms. Targeting the psychological processes underlying these identification stage abnormalities might offer a novel means of treating positive and negative symptoms in schizophrenia.

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Data availability

Data are publicly available in the NIH NDA database online.

Code availability

A link to R code is available in supplemental materials.

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Funding

Research was supported by NIMH grant R21-MH112925 to Dr. Strauss.

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  1. Department of Psychology, University of Georgia, 125 Baldwin St, Athens, GA, 30602, USA

    Ian M. Raugh & Gregory P. Strauss

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Contributions

GPS designed the study and obtained funding. IMR collected data, performed statistical analyses, and wrote the first draft of the manuscript that was subsequently edited by GPS.

Corresponding author

Correspondence to Gregory P. Strauss.

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Conflict of interest

G.P.S. is one of the original developers of the Brief Negative Symptom Scale (BNSS) and receives royalties and consultation fees from Medavante-ProPhase LLC in connection with commercial use of the BNSS and other professional activities; these fees are donated to the Brain and Behavior Research Foundation. GPS has received honoraria and travel support from Medavante-ProPhase LLC for training pharmaceutical company raters on the BNSS. In the past 2 years, GPS has consulted for and/or been on the speaker bureau for Minerva Neurosciences, Acadia, and Lundbeck pharmaceutical companies. All other authors have no relevant disclosures to report.

Ethical approval

The study was approved by the University of Georgia Institutional Review Board. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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All participants provided written informed consent to participate.

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Raugh, I.M., Strauss, G.P. Deconstructing emotion regulation in schizophrenia: the nature and consequences of abnormalities at the identification stage. Eur Arch Psychiatry Clin Neurosci 272, 1061–1071 (2022). https://doi.org/10.1007/s00406-021-01350-z

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