Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-09T06:14:38.806Z Has data issue: false hasContentIssue false
  • English
  • Français

An ecological momentary assessment evaluation of emotion regulation abnormalities in schizophrenia

Published online by Cambridge University Press:  24 January 2018

Katherine Frost Visser ,
Farnaz Zamani Esfahlani ,
Hiroki Sayama  and
Gregory P. Strauss
Katherine Frost Visser
Affiliation:
Department of Psychology, University of Georgia, GA, USA
Farnaz Zamani Esfahlani
Affiliation:
Department of Systems Science and Industrial Engineering, Binghamton University, NY, USA
Hiroki Sayama
Affiliation:
Department of Systems Science and Industrial Engineering, Binghamton University, NY, USA
Gregory P. Strauss*
Affiliation:
Department of Psychology, University of Georgia, GA, USA
*
Author for correspondence: Gregory P. Strauss, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Prior studies using self-report questionnaires and laboratory-based methods suggest that schizophrenia is characterized by abnormalities in emotion regulation (i.e. using strategies to increase or decrease the frequency, duration, or intensity of negative emotion). However, it is unclear whether these abnormalities reflect poor emotion regulation effort or adequate effort, but limited effectiveness. It is also unclear whether dysfunction results primarily from one of the three stages of the emotion regulation process: identification, selection, or implementation.

Method

The current study used ecological momentary assessment (EMA) to address these questions in the context of everyday activities. Participants included 28 outpatients diagnosed with schizophrenia (SZ) and 28 demographically matched healthy controls (CN) who completed 6 days of EMA reports of in-the-moment emotional experience, emotion regulation strategy use, and context.

Results

Results indicated that SZ demonstrated adequate emotion regulation effort, but poor effectiveness. Abnormalities were observed at each of the three stages of the emotion regulation process. At the identification stage, SZ initiated emotion regulation efforts at a lower threshold of negative emotion intensity. At the selection stage, SZ selected more strategies than CN and strategies attempted were less contextually appropriate. At the implementation stage, moderate to high levels of effort were ineffective at decreasing negative emotion.

Conclusions

Findings suggest that although SZ attempt to control their emotions using various strategies, often applying more effort than CN, these efforts are unsuccessful; emotion regulation abnormalities may result from difficulties at the identification, selection, and implementation stages.

Keywords

Affectexperience samplingpsychosis
Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 14 , October 2018 , pp. 2337 - 2345
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Preliminary data presented at the 2017 International Congress on Schizophrenia Research and the 2016 Society for Affective Science Annual Conference. Funding: NIMH K23MH092530 and State University of New York Interdisciplinary Collaboration Grant to Dr Strauss.

References

Aldao, A and Nolen-Hoeksema, S (2010). Specificity of cognitive emotion regulation strategies: A transdiagnostic examination. Behaviour Research and Therapy 48, 974–983.Google Scholar
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn.–Text Revision (DSM-IV-TR). Washington, DC: American Psychiatric Association.Google Scholar
Ardizzi, M, Ambrosecchia, M, Buratta, L, Ferri, F, Peciccia, M, Donnari, S et al. (2016). Interoception and positive symptoms in schizophrenia. Frontiers in Human Neuroscience 10, 379.Google Scholar
Badcock, JC, Paulik, G and Maybery, MT (2011). The role of emotion regulation in auditory hallucinations. Psychiatry Research 185, 303–308.Google Scholar
Baslet, G, Termini, L and Herbener, E (2009). Deficits in emotional awareness in schizophrenia and their relationship with other measures of functioning. The Journal of Nervous and Mental Disease 197, 655.Google Scholar
Ben-Zeev, D (2012). Mobile technologies in the study, assessment, and treatment of schizophrenia. Schizophrenia Bulletin 38, 384–385.Google Scholar
Ben-Zeev, D, Brenner, CJ, Begale, M, Duffecy, J, Mohr, DC and Mueser, KT (2014). Feasibility, acceptability, and preliminary efficacy of a smartphone intervention for Schizophrenia. Schizophrenia Bulletin 40, 1244–1253.Google Scholar
Butler, EA, Gross, JJ and Barnard, K (2014). Testing the effects of suppression and reappraisal on emotional concordance using a multivariate multilevel model. Biological Psychology 98, 6–18.Google Scholar
Depp, CA, Moore, RC, Dev, SI, Mausbach, BT, Eyler, LT and Granholm, EL (2016). The temporal course and clinical correlates of subjective impulsivity in bipolar disorder as revealed through ecological momentary assessment. Journal of Affective Disorders 193, 145–150.Google Scholar
First, MB, Spitzer, RL, Gibbon, M and Williams, JBW (2002). Structured Clinical Interview for DSM-IV-TR Axis 1 Disorders, Research Version, Patient Edition. (SCID-I/P). New York: Biometrics Research, New York State Psychiatric Institute.Google Scholar
Foussias, G and Remington, G (2010). Negative symptoms in schizophrenia: avolition and Occam's razor. Schizophrenia Bulletin 36, 359–369.Google Scholar
Fredrickson, BL, Turgade, MM, Waugh, CE and Larkin, GR (2003). What good are positive emotions in crisis? A prospective study of resilience and emotions following the terrorist attacks on the United States on September 11th, 2001. Journal of Personality and Social Psychology 84, 365–376.Google Scholar
Gard, DE, Kring, AM, Gard, MG, Horan, WP and Green, MF (2007). Anhedonia in schizophrenia: distinctions between anticipatory and consummatory pleasure. Schizophrenia Research 93, 253–260.Google Scholar
Granholm, E, Ben-Zeev, D, Fulford, D and Swendsen, J (2013). Ecological Momentary Assessment of social functioning in schizophrenia: impact of performance appraisals and affect on social interactions. Schizophrenia Research 145, 120–124.Google Scholar
Granholm, E, Loh, C and Swendsen, J (2008). Feasibility and validity of computerized ecological momentary assessment in schizophrenia. Schizophrenia Bulletin 34, 507–514.Google Scholar
Green, MF, Bearden, CE, Cannon, TD, Fiske, AP, Hellemann, GS, Horan, WP et al. (2012). Social cognition in schizophrenia, part 1: performance across phase of illness. Schizophrenia Bulletin 38, 854–864.Google Scholar
Gross, JJ (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology 2, 271–299.Google Scholar
Gross, JJ (2015). Emotion regulation: current status and future prospects. Psychological Inquiry 26, 1–26.Google Scholar
Gruber, J, Kogan, A, Mennin, D and Murray, G (2013). Real-world emotion? An experience-sampling approach to emotion experience and regulation in bipolar I disorder. Journal of Abnormal Psychology 122, 971–983.Google Scholar
Haddock, G, McCarron, J, Tarrier, N and Farragher, EB (1999). Scales to measure dimensions of hallucinations and delusions: the psychotic symptoms rating scale (PSYRATS). Psychological Medicine 29, 879–889.Google Scholar
Hawk, AB, Carpenter, WT and Strauss, JS (1975). Diagnostic criteria and five-year outcome in schizophrenia. A report from the International Pilot Study of schizophrenia. Archives of General Psychiatry 32, 343–347.Google Scholar
Henry, JD, Rendell, PG, Green, MJ, McDonald, S and O'Donnell, M (2008). Emotion regulation in schizophrenia: affective, social, and clinical correlates of suppression and reappraisal. Journal of Abnormal Psychology 117, 473–478.Google Scholar
Horan, WP, Hajcak, G, Wynn, JK and Green, MF (2013). Impaired emotion regulation in schizophrenia: evidence from event-related potentials. Psychological Medicine 43, 2377–2391.Google Scholar
Jaya, ES, Ascone, L and Lincoln, TM (2016 a). Social adversity and psychosis: the mediating role of cognitive vulnerability. Schizophrenia Bulletin 43, 557–565.Google Scholar
Jaya, ES, Hillmann, TE, Reininger, KM, Gollwitzer, A and Lincoln, TM (2016 b). Loneliness and psychotic symptoms: the mediating role of depression. Cognitive Therapy and Research 41, 1–11.Google Scholar
Kee, KS, Horan, WP, Salovey, P, Kern, RS, Sergi, MJ, Fiske, AP et al. (2009). Emotional intelligence in schizophrenia. Schizophrenia Research 107, 61–68.Google Scholar
Kimhy, D, Gill, KE, Brucato, G, Vakhrusheva, J, Arndt, L, Gross, JJ et al. (2016). The impact of emotion awareness and regulation on social functioning in individuals at clinical high risk for psychosis. Psychological Medicine, 46, 2907–2918.Google Scholar
Kimhy, D, Vakhrusheva, J, Jobson-Ahmed, L, Tarrier, N, Malaspina, D and Gross, JJ (2012). Emotion awareness and regulation in individuals with schizophrenia: implications for social functioning. Psychiatry Research 200, 193–201.Google Scholar
Kirkpatrick, B, Strauss, GP, Nguyen, L, Fischer, BA, Daniel, DG, Cienfuegos, A et al. (2011). The brief negative symptom scale: psychometric properties. Schizophrenia Bulletin 37, 300–305.Google Scholar
Lamster, F, Lincoln, T, Nittel, C, Rief, W and Mehl, S (2017). The lonely road to paranoia. A path-analytic investigation of loneliness and paranoia. Comprehensive Psychiatry 74, 35–43.Google Scholar
Livingstone, K, Harper, S and Gillanders, D (2009). An exploration of emotion regulation in psychosis. Clinical Psychology and Psychotherapy 16, 418–430.Google Scholar
Moran, EK, Culbreth, AJ and Barch, DM (2017). Ecological momentary assessment of negative symptoms in schizophrenia: relationships to effort-based decision making and reinforcement learning. Journal of Abnormal Psychology 126, 96.Google Scholar
Morris, R, Sparks, A, Mitchell, P, Weickert, C and Green, M (2012). Lack of cortico-limbic coupling in bipolar disorder and schizophrenia during emotion regulation. Translational Psychiatry 2, e90.Google Scholar
Moritz, S and Laudan, A (2007). Attention bias for paranoia-relevant visual stimuli in schizophrenia. Cognitive Neuropsychiatry 12, 381–390.Google Scholar
Myin-Germeys, I, Delespaul, PA and deVries, MW (2000). Schizophrenia patients are more emotionally active than is assumed based on their behavior. Schizophrenia Bulletin 26, 847–854.Google Scholar
Nuechterlein, KH, Green, MF, Kern, RS, Baade, LE, Barch, DM, Cohen, JD et al. (2008). The MATRICS Consensus Cognitive Battery, part 1: test selection, reliability, and validity. American Journal of Psychiatry 165, 203–213.Google Scholar
Overall, JE and Gorham, DR (1962). The brief psychiatric rating scale. Psychological Reports 10, 799–812.Google Scholar
Perry, Y, Henry, JD and Grisham, JR (2011). The habitual use of emotion regulation strategies in schizophrenia. British Journal of Clinical Psychology 50, 217–222.Google Scholar
Pfohl, BM, Blum, N and Zimmerman, M (1997). Structured Interview for DSM-IV Personality, 1st edn. Arlington: American Psychiatric Publishing, Inc.Google Scholar
Rowland, JE, Hamilton, MK, Lino, BJ, Ly, P, Denny, K, Hwang, EJ et al. (2013). Cognitive regulation of negative affect in schizophrenia and bipolar disorder. Psychiatry Research 208, 21–28.Google Scholar
Sanchez, AH, Lavaysse, LM, Starr, JN and Gard, DE (2014). Daily life evidence of environment-incongruent emotion in schizophrenia. Psychiatry Research 220, 89–95.Google Scholar
Shiffman, S, Stone, AA and Hufford, MR (2008). Ecological momentary assessment. Annual Review of Clinical Psychology 4, 1–32.Google Scholar
Sheppes, G, Suri, G and Gross, JJ (2015). Emotion regulation and psychopathology. Annual Review of Clinical Psychology 11, 379–405.Google Scholar
Strauss, GP, Catalano, LT, Llerena, K and Gold, JM (2013 a). The processing of emotional stimuli during periods of limited attentional resources in schizophrenia. Journal of Abnormal Psychology 122, 492.Google Scholar
Strauss, GP, Hong, LE, Gold, JM, Buchanan, RW, McMahon, RP, Keller, WR et al. (2012 a). Factor structure of the brief negative symptom scale. Schizophrenia Research 142, 96–98.Google Scholar
Strauss, GP, Kappenman, ES, Culbreth, AJ, Catalano, LT, Lee, BG and Gold, JM (2013 b). Emotion regulation abnormalities in schizophrenia: cognitive change strategies fail to decrease the neural response to unpleasant stimuli. Schizophrenia Bulletin 39, 872–883.Google Scholar
Strauss, GP, Kappenman, ES, Culbreth, AJ, Catalano, LT, Ossenfort, KL, Lee, BG et al. (2015). Emotion regulation abnormalities in schizophrenia: directed attention strategies fail to decrease the neurophysiological response to unpleasant stimuli. Journal of Abnormal Psychology 124, 288–301.Google Scholar
Strauss, GP, Keller, WR, Buchanan, RW, Gold, JM, Fischer, BA, McMahon, RP et al. (2012b). Next-generation negative symptom assessment for clinical trials: validation of the Brief Negative Symptom Scale. Schizophrenia Research 142, 88–92.Google Scholar
Strauss, GP, Llerena, K and Gold, JM (2011). Attentional disengagement from emotional stimuli in schizophrenia. Schizophrenia Research 131, 219–223.Google Scholar
Sullivan, SK and Strauss, GP (2017). Electrophysiological evidence for detrimental impact of a reappraisal emotion regulation strategy on subsequent cognitive control in schizophrenia. Journal of Abnormal Psychology 126, 679–693.Google Scholar
Swendsen, J, Ben-Zeev, D and Granholm, E (2011). Real-time electronic ambulatory monitoring of substance use and symptom expression in schizophrenia. American Journal of Psychiatry 168, 202–209.Google Scholar
Van der Velde, J, Swart, M, van Rijn, S, van der Meer, L, Wunderink, L, Wiersma, D et al. (2015). Cognitive alexithymia is associated with the degree of risk for psychosis. PLoS ONE 10, e0124803.Google Scholar
Van Rijn, S, Schothorst, P, Wout, M, Sprong, M, Ziermans, T, van Engeland, H et al. (2011). Affective dysfunctions in adolescents at risk for psychosis: emotion awareness and social functioning. Psychiatry Research 187, 100–105.Google Scholar
van der Meer, L, Swart, M, van der Velde, J, Pijnenborg, G, Wiersma, D, Bruggeman, R et al. (2014). Neural correlates of emotion regulation in patients with schizophrenia and non-affected siblings. PLoS ONE 9, e99667.Google Scholar
van der Meer, L, van't Wout, M and Aleman, A (2009). Emotion regulation strategies in patients with schizophrenia. Psychiatry Research 170, 108–113.Google Scholar
Walker, EF and Diforio, D (1997). Schizophrenia: a neural diathesis-stress model. Psychological Review 104, 667.Google Scholar
Walker, E, Mittal, V and Tessner, K (2008). Stress and the hypothalamic pituitary adrenal axis in the developmental course of schizophrenia. Annual Review of Clinical Psychology 4, 189–216.Google Scholar
Supplementary material: File

Visser et al. supplementary material

Visser et al. supplementary material 1

Download Visser et al. supplementary material(File)
File 1.4 MB