Emotion regulation (ER) flexibility is highly relevant to psychosis-proneness as it influences how individuals adapt to and manage their emotional responses in varying contexts. Research suggests that deficits in ER flexibility components, particularly context sensitivity and emotional suppression, may contribute to the development and maintenance of psychotic-like experiences. Understanding this relationship can inform early intervention strategies and tailored treatments for individuals at risk of psychosis, potentially improving outcomes and quality of life.
Key Points
Rationale
Previous research has established that emotional dysregulation is a central feature of psychosis, with implications for its onset and maintenance (Liu et al., 2020; Ludwig et al., 2019).
Recent studies have highlighted the importance of flexibility in emotion regulation (ER) in relation to psychosis (Bonanno & Burton, 2013).
However, longitudinal research was needed to better understand the causal relationships between ER flexibility components and psychotic-like experiences (PLE).
Additionally, investigating both the frequency and associated distress of PLE could provide insights into factors that differentiate subclinical experiences from clinical psychosis.
This study aimed to replicate and extend Bortolon et al.’s (2022) findings using both cross-sectional and longitudinal designs, examining how specific components of ER flexibility (context sensitivity, repertoire, and feedback) relate to PLE over time.
Method
Participants completed questionnaires at two time-points (T1 and T2) through an online platform. At T1, they completed measures of ER flexibility components and psychosis-proneness. At T2, they completed only the psychosis-proneness measure again.
The initial sample consisted of 303 English-speaking adults from the UK and US recruited through the Prolific platform. At T2, 249 participants completed the follow-up survey.
The mean age of participants was 43.94 years (SD = 14.96) at T1.
The study used correlational analyses, linear regressions, and bootstrapping techniques to analyze the data. Regression diagnostics were performed to ensure the validity of the models.
Results
Hypothesis: Deficits in context sensitivity, repertoire, and feedback responsiveness at T1 would predict higher scores on psychosis-proneness (both frequency and distress) at T2.
Insight
The study provides evidence for the role of specific ER flexibility components in the development and maintenance of PLE.
The ability to detect the absence of contextual cues appears to have differential effects on positive and negative symptoms, suggesting a complex relationship between context sensitivity and psychosis-proneness.
These results suggest that interventions targeting ER flexibility, particularly context sensitivity and emotional suppression abilities, may be beneficial in preventing or managing PLE.
Future research should explore potential bidirectional relationships between PLE and ER flexibility deficits, as well as investigate these relationships in clinical populations.
Strengths
Limitations
These limitations may affect the generalizability of the findings and the ability to draw strong causal conclusions. Future studies should consider using longer follow-up periods, multiple assessment points for all variables, and more diverse samples.
Clinical Implications
The findings have significant implications for understanding the development and maintenance of psychotic experiences.
They suggest that targeting specific ER flexibility components, particularly context sensitivity and emotional suppression abilities, may be beneficial in clinical interventions for individuals at risk of psychosis.
The differential associations between cue absence detection and positive vs. negative symptoms highlight the need for nuanced approaches in treatment.
For clinical practice, these results emphasize the importance of assessing and addressing ER flexibility skills in individuals with PLE. Interventions could focus on improving context sensitivity, particularly the ability to accurately detect the presence and absence of contextual cues. A
Additionally, helping individuals develop more adaptive emotional suppression abilities may be beneficial in managing positive symptoms.
The study also underscores the complexity of the relationship between ER and psychosis, suggesting that a one-size-fits-all approach to ER interventions may not be appropriate.
Clinicians should consider the specific symptom profile and ER deficits of each individual when designing interventions.
References
Primary reference
Nardelli, C., Bonanno, G. A., Chen, S., & Bortolon, C. (2024). Emotion regulation flexibility and psychosis: A longitudinal study disentangling components of flexibility in psychosis‐proneness. BritishJournal of Clinical Psychology, 63(1), 54-72.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.
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.
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Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
