Deconstructing Emotion Regulation in Schizophrenia: The Nature and Consequences of Positive Emotion Up-Regulation Abnormalities

Many forms of psychopathology display abnormalities in down-regulating negative affect (NA). In schizophrenia (SZ), these abnormalities occur at all stages of emotion regulation (identification, selection, implementation) and the nature of these impairments predicts individual differences in clinical presentation. While NA down-regulation is important, regulatory goals can also focus on up- or down-regulating positive affect (PA). It is unclear whether the same pattern of abnormalities observed for NA down-regulation also occurs for PA regulation and whether it predicts negative symptoms (e.g., anhedonia). The current study used ecological assessment (EMA) to examine PA regulation abnormalities in SZ in real-world contexts. Participants included 39 outpatients diagnosed with SZ and 34 healthy controls (CN) who completed 6 days of EMA surveys assessing NA, PA, emotion regulation, and anhedonia. PA down-regulation rates were similarly low in both groups. The intensity of PA did not interact with group for identification rate, strategies selected, or implementation effectiveness, suggesting that PA up-regulation was relatively normal in SZ. However, the intensity of NA predicted the need to up-regulate PA, suggesting that regulation of PA was initiated in response to NA. Further, this relationship differed between the groups such that SZ regulated PA more frequently and with more effort at lower levels of NA. Yet, these regulatory attempts were ineffective at decreasing the severity of anhedonia, and SZ were less effective than CN at decreasing the intensity of NA. Overall, the pattern of emotion regulation abnormalities observed in SZ differs based upon regulatory goals. Abnormalities in regulating NA may be more central to psychopathology in SZ than abnormalities in PA.