Emotion regulation involves our ability to manage feelings. It encompasses the strategies and thought processes we use to shape what emotions we have, when we have them, and how these emotions are mentally and physically expressed.
For example, taking deep breaths to calm anger or reevaluating a situation more positively are emotion regulation skills.
Deficits in regulating emotions adaptively are linked to difficulties coping as well as mental health problems. Essentially, emotion regulation determines how skillfully we handle feelings.
Nardelli, C., Bonanno, G. A., Chen, S., & Bortolon, C. (2023). Emotion regulation flexibility and psychosis: A longitudinal study disentangling components of flexibility in psychosis‐proneness. British Journal of Clinical Psychology. https://doi.org/10.1111/bjc.12443
Key Points
The paper presents findings from a longitudinal study examining the relationship between emotion regulation flexibility and psychosis-proneness in a non-clinical sample. Key points include:
- Deficits in two components of emotion regulation flexibility (context sensitivity and expressive suppression) predicted increased psychotic-like experiences over a 3-month period.
- The ability to detect the absence of contextual cues predicted both positive and negative psychotic-like symptoms through opposite pathways.
- Expressive suppression specifically predicted increased positive symptoms over time.
- Emotion regulation flexibility was not predictive of distress associated with psychotic-like experiences.
- The findings support the role of specific emotion regulation deficits in the longer-term maintenance of attenuated psychotic symptoms in the general population.
Rationale
Emotion dysregulation is considered central to the onset and persistence of psychotic disorders (Liu et al., 2020; Ludwig et al., 2019).
Research has demonstrated affective disturbances across the extended psychosis phenotype, including in relation to subclinical psychotic-like experiences (PLEs) in non-clinical groups (Kelleher et al., 2010).
Flexible deployment of emotion regulation strategies has been proposed as an important contributor to resilience and mental health (Bonanno & Burton, 2013).
A prior cross-sectional study found links between regulatory flexibility and PLEs (Bortolon et al., 2022) preliminarily.
The current study aimed to replicate and extend those initial findings using a longitudinal design to assess predictive relationships over time.
Examining subclinical samples on the psychosis continuum allows for the observation of psychological processes separate from confounds like medication effects in diagnosed groups (Larøi, 2012).
Clarifying links between regulatory capabilities and emergent psychotic phenomena may explain risk and maintaining factors.
Method
The study utilized a longitudinal correlational design.
Participants were assessed at two-time points separated by approximately three months.
Self-report measures assessed emotion regulation flexibility, including context sensitivity, regulatory repertoire, and use of feedback.
PLEs were measured via self-reports of hallucinatory experiences and delusional ideation over the past three months. Linear regression analyses examined whether flexibility components predicted symptom levels over time, controlling for baseline symptoms.
The sample included 522 young adults recruited from a French university. Most participants were female (80.3%) with a mean age of 20.38 years.
Representativeness to the broader population may be limited by the homogeneous, restricted sample. Self-reports can introduce subjectivity biases.
Results
Expressive suppression ability predicted increases in positive PLE symptoms over time but did not predict negative symptoms or distress.
Detection of absent contextual cues predicted increased negative symptoms and decreased positive symptoms longitudinally. Other flexibility facets showed no longitudinal relationships to PLEs.
Insight
The findings highlight specific emotion regulation deficits that may contribute to subclinical psychotic phenomena over time.
This supports proposed transdiagnostic models wherein regulatory capabilities impact the emergence of various symptom profiles (Fernandez et al., 2016).
Results further suggest some psychotic dimensions may have differential underlying pathways—contextual detection related in opposite ways to negative versus positive symptoms.
Strengths
- A longitudinal design was used, allowing for the examination of temporal prediction.
- Assessed multiple components of regulatory flexibility.
- Distinctly measured different symptom dimensions of PLEs.
- Focused on understudied subclinical phenomena on the extended psychosis continuum.
Limitations
- The sample was restricted to a narrow young adult student population, limiting generalizability.
- Findings relied solely on subjective self-report measures.
- A brief follow-up period of three months. Longer assessments could observe enduring predictive effects.
- Possible third variable factors underlying relationships were not directly examined.
Implications
This research aids clinical efforts to delineate specific regulatory processes that may contribute to attenuated psychotic symptoms over time.
Tailoring interventions to target deficiencies in contextual appraisal and expressive control could help disrupt risk trajectories.
Findings support emotion regulation as an area of focus in early psychosis intervention.
Research should clarify bidirectional relationships and underlying mechanisms using multi-wave assessments. Insights could inform the refinement of cognitive-behavioral treatments and help identify at-risk subgroups for selective prevention.
Conclusions
Emotion regulation flexibility plays an important role in mental health. This research found that over a 3-month period, college students who had more difficulty detecting emotional cues or controlling emotional expression reported increases in unusual thoughts and perceptions. These subclinical symptoms resemble attenuated versions of psychotic disorders.
The findings suggest that evaluating context and expressing feelings adaptively may help prevent symptoms of psychosis from worsening over time.
When university students show early subclinical signs, counseling staff could provide targeted skill-building. Helping students handle emotions more flexibly may stop unusual thoughts from escalating.
Further studies should track larger, more diverse samples of students for a longer follow-up period. Clarifying links between specific emotion regulation capabilities and dimensions of emerging atypical thoughts can support refined counseling approaches.
It may also aid future early intervention efforts to curb psychosis risk trajectories before clinical severity. Overall, tailored training in mood management skills shows promise for selectively safeguarding mental wellness.
References
Primary reference
Nardelli, C., Bonanno, G. A., Chen, S., & Bortolon, C. (2023). Emotion regulation flexibility and psychosis: A longitudinal study disentangling components of flexibility in psychosis‐proneness. British Journal of Clinical Psychology. https://doi.org/10.1111/bjc.12443
Other references
Bonanno, G. A., & Burton, C. L. (2013). Regulatory flexibility: An individual differences perspective on coping and emotion regulation. Perspectives on Psychological Science, 8(6), 591–612.
Bortolon, C., Chen, S., & Bonanno, G. A. (2022). Components of emotion regulation flexibility and psychosis: The association between psychosis-proneness and context sensitivity. British Journal of Clinical Psychology, 62(1), 82–95.
Fernandez, K. C., Jazaieri, H., & Gross, J. J. (2016). Emotion regulation: A transdiagnostic perspective on a new RDoC domain. Cognitive therapy and research, 40, 426-440.
Kelleher, I., Jenner, J. A., & Cannon, M. (2010). Psychotic symptoms in the general population–an evolutionary perspective. The British Journal of Psychiatry, 197(3), 167–169.
Larøi, F. (2012). How do auditory verbal hallucinations in patients differ from those in non-patients? Frontiers in Human Neuroscience, 6, 25.
Liu, J., Chan, T. C., Chong, S. A., Subramaniam, M., & Mahendran, R. (2020). Impact of emotion dysregulation and cognitive insight on psychotic and depressive symptoms during the early course of schizophrenia spectrum disorders. Early Intervention in Psychiatry, 14(6), 691–697.
Ludwig, L., Werner, D., & Lincoln, T. M. (2019). The relevance of cognitive emotion regulation to psychotic symptoms–a systematic review and meta-analysis. Clinical Psychology Review, 72, 101746.
Van Os, J., Linscott, R. J., Myin-Germeys, I., Delespaul, P., & Krabbendam, L. (2009). A systematic review and meta-analysis of the psychosis continuum: Evidence for a psychosis proneness–persistence–impairment model of psychotic disorder. Psychological Medicine, 39(2), 179–195.
Learning Check
Here are some potential Socratic discussion questions about this paper for a college class:
- What are some possible third variables that could underlie the relationships found between regulatory deficits and increases in psychotic symptoms over time? What future research approaches could help rule out these third variable explanations?
- The study found regulation facets linked differently to positive versus negative dimensions of PLEs – what might account for these differential relationships? How might specific types of emotion regulation tie into specific types of psychotic phenomena?
- The sample consisted only of college students – what are limitations of this in terms of generalizing such findings to a clinical population? What comparisons or contrasts might we expect to find using a clinical group?
- What might be the practical implications of these findings for university counseling services? If a student presented with early indications of PLEs, how could counselors make use of these results in treatment planning?
- The study discusses emotion regulation as transdiagnostic, meaning it relates to multiple disorders. How might deficits observed here manifest across other conditions like anxiety, depression or PTSD? Could regulatory abilities be a common risk or maintaining factor?
- What might a bidirectional relationship between PLEs and regulation difficulties look like? How could the emergence of symptoms undermine one’s ability to regulate emotions effectively over time? What research methods could best disentangle this?
