Emotion regulation patterns of psychotic patients and their affect

Abstract

Background: In recent years, the study of emotion in psychosis has been neglected, and it would seem from the literature that emotion is not related to the formation or prediction of psychosis. Because emotions are the subjective experience of patients, they are not easily quantified. However, the latest fMRI research has shown that emotion and brain function are related and that understanding emotion is valuable for understanding patients’ cognitive function and its potential relationship with psychosis. Emotion regulation can be divided into two different categories based on when in the sequence of emotion regulation they appear. Cognitive reappraisal is antecedent-focused, and suppression is response-focused. I hypothesize that cognitive reappraisal can decrease maladaptive thought and emotions. In contrast, expressive suppression can reduce the appearance of emotion but not inner emotion. Furthermore, inhibiting a preference may not stop maladaptive emotions from arising over a long period of time.

Methods: Two groups were recruited in study: a clinical group of patients with psychosis and a nonclinical group of healthy adolescents with no record of mental illness. Twenty-four psychotic patients were recruited from Early Assessment Services for Young People (EASY) in Queen Mary Hospital, and 30 nonclinical participants were recruited from nongovernmental organizations and schools. The participants ranged from 17 to 34 years old and were native Cantonese speakers living in Hong Kong. They completed a variety of measures of emotion regulation, depression, and anxiety.

Results: The clinical and nonclinical groups were similar on several dimensions, including their demographic information and pattern of strategy usage. A higher percentage used both emotion-regulation strategies to cope with maladaptive emotion, and fewer used a single strategy. However, the two groups had significantly different outcomes from using expressive suppression as their major emotion regulation pattern. The clinical group was more likely to have higher depressive symptoms (moderate to severe levels on the Beck Depression Inventory).

Conclusion: It is valuable to assess emotion-regulation strategies in order to evaluate patients’ habitual coping strategy. Cognitive reappraisal seems to allow participants to retain their cognitive function when maladaptive emotions are not fully occupying their cognitive resources. In contrast, when maladaptive emotion reaches a very high level, it cannot be contained through cognitive reappraisal. Habitual use of expressive suppression affects cognitive functioning and depletes resources that could be used for other regulation attempts. Unsuccessfully regulated maladaptive emotions could be a risk factor that occupies the cognitive functioning of psychotic patients. In order to solidify this hypothesis, further longitudinal research on psychotic patients’ emotional history is needed. More research is needed to understand the relationship between maladaptive emotions, cognitive function, and psychosis.