Dysfunctional Emotion Regulation as a Vulnerability Marker for Psychosis: the Twinsscan China Study

Abstract

BACKGROUND: Individuals with psychosis have been found to engage in similar emotion regulation practices as those with mood and anxiety disorders. What remains unclear is whether these dysfunctional approaches arise as a reaction to the psychosis or are present before the onset of the disorder, thus potentially representing important vulnerability factors for psychosis. This pilot study aims to build on the existing literature through examining the relationship between psychosis proneness and two maladaptive forms of emotion regulation: rumination and emotion suppression. It is hypothesized that individuals with higher psychosis proneness scores will report ruminating more about a negative event as well as expressing less emotion in response to this event. To our knowledge, this is the first study to assess emotion regulation strategies using ESM (The Experienced Sampling method) in the normal Chinese population. METHODS: Pilot data were collected from 51 healthy Chinese adolescent participants (twin pairs = 22, individuals = 7) with no known history of mental disorder. Psychosis proneness was measured using the Community Assessment for Psychic Experiences: a 42-item questionnaire designed to measure the frequency and severity of psychotic-like experiences in the general population. Rumination and emotion suppression were measured using the Psymate, a pager-like device used for Experienced Sampling. Participants carried the Psymate for a mean of 5.8 days. Participants were asked daily to first think about the most negative event of the day. They were then asked to rate “I thought about it often” (rumination) and “I showed my emotions” (emotion suppression) on a 7-point likert scale. RESULTS: Multilevel regression analysis revealed rumination and emotion suppression to both significantly predict psychosis proneness (rumination: b=0.11, 95% CI = 0.020, 0.19, p=0.017; emotion suppression: b=−0.12, 95% CI = −0.21, −0.03, p=0.009). Supporting our hypothesis, individuals with higher psychosis proneness scores reported ruminating more after negative events and expressing less emotion than those participants with lower psychosis proneness scores. DISCUSSION: This pilot study provides insight into the relationship between psychosis proneness and dysfunctional emotion regulation strategies. Specifically, the findings show that rumination and emotion suppression may be present before the onset of the disorder, suggesting them as potential vulnerability markers for psychosis. These findings indicate that interventions aimed at changing emotion regulation strategies are likely to be beneficial for at risk individuals. Future research employing a longitudinal design would confirm these findings.