Emotional regulation as a mediating variable between risk of psychosis and common mental health problems in adolescents

The main clinical high-risk of psychosis (CHRp) approaches are focused on core features of schizophrenia that might surface in the prodromal phases, mainly psychotic-like experiences (PLEs) (e.g., prodromal or schizotypal symptoms) or associated phenomena like basic symptoms or anomalous experiences of the self. Given that PLEs vary depending on distress levels, related common mental health problems, emotional regulation (ER) strategies and eventual clinical outcomes, exploring the heterogeneous nature of these PLEs and their psychological correlates could aid in distinguishing between subclinical and clinical psychotic experiences. The present study aims firstly to generate new evidence on the understanding of clinical relevance of PLEs and associated phenomena in a non-clinical representative sample of 1824 Spanish adolescents, according to their CHRp level (high/moderate/low). Secondly, we analyzed the possible mediating effect of three different emotional regulation strategies ((experiential avoidance (EA), cognitive reappraisal (CR) and emotional suppression (ES)) between PLEs and non-specific symptoms of depression, anxiety, stress, trauma related distress and substance use. Results showed that a more frequent use of EA and ES resulted in a higher CHRp, with no differences in the use of CR. In addition, EA emerged as a significant mediating factor between CHRp and the development of emotional symptoms and substance use. Emotion regulation strategy may account for heterogeneity in PLE outcomes. The use of EA as a coping strategy for their PLEs in adolescents with CHRp may facilitate the development of common mental health problems such as anxiety, depression or cannabis use pathologies. Helping adolescents at CHRp to use non-avoidant coping strategies may be indicated if their preventive effects are demonstrated.