Neurophysiological evidence for emotion regulation abnormalities in individuals at clinical high-risk for psychosis

Past studies indicate that individuals at clinical high-risk for psychosis (CHR) display emotion regulation abnormalities that predict increased symptom severity and poor functional outcome. However, it is unclear which neurophysiological processes contribute to impairments in implementing various strategies to down-regulate negative emotion. The current study used electroencephalography (EEG) to determine whether individuals at CHR have difficulty implementing reappraisal and distraction. Participants included individuals at CHR (n = 25) and healthy controls (CN: n = 36) who completed an EEG task while unpleasant or neutral stimuli were presented and they were required to either passively view or down-regulate negative emotion using reappraisal or distraction. The late positive potential (LPP) event related potential component was calculated from the EEG data and used as an objective neurophysiological indicator of emotion regulation effectiveness. CN effectively decreased the amplitude of the LPP for both reappraisal and distraction compared with unpleasant passive viewing; however, CHR did not differ in LPP amplitude for unpleasant passive viewing, reappraisal, and distraction, suggesting an implementation abnormality. Difficulty implementing distraction was associated with greater severity of attenuated positive symptoms. Collectively, these findings suggest that CHR display neurophysiological patterns of emotion regulation impairment that are similar to those that have been identified among individuals with schizophrenia in past studies. Interventions have been developed to target these mechanisms. It may be beneficial to apply these interventions to psychosis-spectrum populations where they would have relevance for both treatment of established symptoms and prevention of illness among those at CHR.