Emotion-Regulation in Psychosis: Patients with Psychotic Disorders Apply Reappraisal Successfully
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ORIGINAL ARTICLE
Emotion‑Regulation in Psychosis: Patients with Psychotic Disorders Apply Reappraisal Successfully Sandra M. Opoka1 · Johanna Sundag1 · Marcel Riehle1 · Tania M. Lincoln1 Accepted: 30 September 2020 © The Author(s) 2020
Abstract Background Emotion-regulation is assumed to be impaired in psychosis: patients with psychotic disorders (PD) self-report to use reappraisal less frequently than healthy controls (HC), but it is uncertain whether they are also less successful in applying reappraisal. Moreover, it has not been investigated whether the habitual use of reappraisal is associated with the ability to use reappraisal successfully. Methods To address these questions, PD (n = 60), a clinical control group of patients with anxiety disorders (AD; n = 40) and HC (n = 40) completed questionnaires on habitual emotion-regulation and alexithymia, performed tests on neurocognitive functioning and jumping-to-conclusion bias, and were subjected to an emotion-regulation paradigm, in which they were asked to down-regulate induced anxiety and sadness. Results No differences were found between PD and HC regarding the habitual use of reappraisal, but PD reported to use reappraisal more frequently than AD. All groups were able to down-regulate anxiety and sadness via reappraisal following instructions. The habitual use of reappraisal and the reduction of anxiety and sadness after instruction were uncorrelated. Conclusion These findings question the common assumption that PD use reappraisal less often or less successfully. At least under laboratory condition, PD do not appear to be impaired in reducing negative affect via reappraisal successfully. Keywords Psychosis · Schizophrenia · Emotion regulation · Reappraisal High rates of depression and anxiety are found in patients with psychotic disorders (PD; meta-analyses: Achim et al. 2011; Li et al. 2020). Negative affect, such as depression and anxiety, is associated with lower quality of life (e.g. Gardsjord et al. 2016; Huppert et al. 2001) and is postulated to contribute to the formation and maintenance of psychotic symptoms (Garety et al. 2001; Hartley et al. 2013). Thus, it does not seem surprising that psychosis is also associated with deficits in emotion-regulation (Ludwig et al. 2019), which was originally defined as “extrinsic and intrinsic processes responsible for monitoring, evaluating, and modifying emotional reactions, especially their intensive and temporal features, to accomplish one’s goals” (Thompson 1994, pp.27–28) and has undergone numerous revisions * Sandra M. Opoka sandra.martha.opoka@uni‑hamburg.de 1
Section for Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, Von‑Melle‑Park 5, 20146 Hamburg, Germany
and extensions since then (e.g. Gross 2015; Hofmann 2014; Hofmann et al. 2012; Koole 2009; Tamir et al. 2015). In this study we focused on one specific emotion-regulation strategy, namely reappraisal. Reappraisal in the context of emotion regulation is comm
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