Featured: Impact of Psychosis on Emotion Regulation

Regulation of emotional experience is an individual’s ability to be aware of and accurately evaluate one’s own emotions. A person who has emotion regulation skills has control over how and when they express their emotions. Emotional regulation is essential in everyday life as it allows people to maintain their mental and emotional states. There are many adaptive and maladaptive emotion regulation strategies that people use to deal with stressful situations in their lives. Adaptive strategies have a positive impact on mental health and well-being, while maladaptive strategies can exacerbate pre-existing mental health conditions. Reappraisal is an important adaptive strategy in which an individual changes their perception of a situation to alter the impact it has on their emotions. Figure 1 shows Lazarus’ transactional model of stress, which displays the process of how individuals regulate their emotions upon experiencing stressful environmental stimuli. The individual in Figure 1 ends in a positive mood due to their use of positive reappraisal. A positive reappraisal of a stressful experience lessens an individual’s negative affect. In the field of psychology, “affect” refers to the internal experience of emotions (Barrett & Bliss-Moreau, 2009).

Fig. 1. Lazarus’ transactional model of stress. This graphic demonstrates a healthy individual’s use of reappraisal in response to stress. A person takes in stimuli from the environment. They have a primary appraisal of the situation, in which they initially assess how it affects them. Then, the person has a secondary appraisal of the situation, in which they assess whether they have the internal (mental/cognitive) or external resources to deal with the situation. If the person lacks resources, they experience stress but find a way to cope. If the person uses positive coping strategies, they go on to positively reappraise the situation, in which they change their perception of it to change the emotional effect it has on them. 
 

Many studies have shown that individuals with psychotic disorders experience higher rates of negative emotions than individuals who do not have psychotic disorders. Psychosis is characterized by the experience of losing touch with reality and having an altered processing of information. It is a common symptom of mental disorders such as schizophrenia. The use of reappraisal in response to stressful situations is a predictor of whether individuals experience negative emotions, so many researchers hypothesized that individuals with psychosis are less successful in reappraising their emotions. Lazarus’ transactional model of stress demonstrates how individuals use reappraisal to regulate their emotions in response to stressful stimuli (see Figure 1).

One study by Ludwig et al. (2020) found that habitual reappraisal was a predictor for decreased negative affect in everyday life. In other words, an individual who tends to use reappraisal in stressful situations is likely to have a less negative experience of emotions. These researchers’ findings imply that individuals who experience psychosis are less successful in regulating their emotions because they use maladaptive strategies to deal with stressful situations. A study by Opoka et al. (2021) had results that contradicted those of Ludwig et al. (2020). Based on prior research, Opoka et al. hypothesized that patients who experience psychosis would apply less reappraisal than healthy individuals. It was also hypothesized that individuals with psychotic disorders would be less successful in regulating negative emotions through reappraisal compared to individuals without psychotic disorders. Based on these hypotheses, a healthy individual would be likely to reappraise their situation more successfully to improve their emotional state (see Figure 1) compared to individuals with psychosis. However, the researchers found that there was no significant difference in the use of reappraisal between patients with psychosis and healthy individuals. Their findings suggest that people with psychosis can successfully reappraise their emotions and that negative emotion regulation is not impaired by the experience of psychosis. Based on the results of the study by Opoka et al., the example in Figure 1 would represent both people with psychosis and people without psychosis.
 

References

Barrett, L. F., & Bliss-Moreau, E. (2009). Affect as a psychological primitive. Advances In Experimental Social Psychology, 41, 167–218. https://doi.org/10.1016/S0065-2601(08)00404-8

Ludwig, L., Mehl, S., Krkovic, K., & Lincoln, T. M. (2020). Effectiveness of emotion regulation in daily life in individuals with psychosis and nonclinical controls—An experience-sampling study. Journal of Abnormal Psychology, 129(4), 408-421. http://dx.doi.org/10.1037/abn0000505

Opoka, S. M., Sundag, J., Riehle, M., & Lincoln, T. M. (2021). Emotion-regulation in psychosis: Patients with psychotic disorders apply reappraisal successfully. Cognitive Therapy and Research, 45(1), 31-45. http://dx.doi.org/10.1007/s10608-020-10163-8