title: Do People With Psychosis Have Specific Difficulties Regulating Emotions?
abstract: Difficulties in emotion regulation (ER) are present in psychotic disorders, but their precise nature is not yet fully understood and it is unclear which difficulties are unique to psychosis compared with other disorders. This study investigated whether ER difficulties in psychosis are more prominent for the ability to modify emotions or for the ability to tolerate and accept them. Furthermore, it investigated whether ER difficulties occur for sadness, anxiety, anger and shame likewise. ER skills were assessed in participants with psychotic disorders (n = 37), participants with depression (n = 30) and healthy controls (n = 28) using the Emotion Regulation Skill Questionnaire that asks participants to rate the intensity of different emotions over the past week and the skills employed to handle each of them. Compared with healthy controls, participants with psychosis showed reduced skills related to awareness, understanding and acceptance of potentially distressing emotions, but not in the ability to modify them. These differences remained significant after controlling for depression. Participants with psychosis showed reduced ER skills in regard to all of the assessed emotions compared with the healthy controls, despite the fact that they only reported sadness as being significantly more intense. The participants with depression showed a similar pattern of ER skills to the psychosis sample, although with a tendency towards even more pronounced difficulties. It is concluded that psychosis is characterized by difficulties in using specific ER skills related to awareness, understanding and acceptance to regulate anger, shame, anxiety and sadness. These difficulties are not unique to psychosis but nevertheless present a promising treatment target.
  
  
  CONCLUSIONS
  The participants with psychosis found it more difficult to be aware of their emotions, to understand them and to accept them than the healthy control group. However, they reported equal skills when it came to actively modifying emotions. The difficulties in emotion regulation reported by the participants with psychosis were comparable with those reported by the participants with depression, and they occurred for all types of negative emotions likewise. The difficulties in using specific ER skills related to awareness, understanding and acceptance are a promising target for psychological treatment of psychosis. Interventions that are aimed specifically at increasing these skills need to be further developed.
authors.affiliation: Clinical Psychology and Psychotherapy, Institute of Psychology, University of Hamburg, Hamburg, 20246, Germany.
authors.forename: Tania M
authors.initials: TM
authors.lastname: Lincoln
authors.affiliation: Clinical Psychology and Psychotherapy, Institute of Psychology, University of Hamburg, Hamburg, 20246, Germany.
authors.forename: Maike
authors.initials: M
authors.lastname: Hartmann
authors.affiliation: Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, D-20246, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Köther
authors.affiliation: Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, D-20246, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Moritz
mesh_terms: D000328:Adult; D004644:Emotions / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D011618:Psychotic Disorders / Q000503:physiopathology* / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Acceptance; Awareness; Depression; Modification; Regulation; Schizophrenia