Skip to main content Accessibility help

Emotion regulation across the psychosis continuum

  • Hannah C. Chapman (a1), Katherine F. Visser (a1), Vijay A. Mittal (a2), Brandon E. Gibb (a3), Meredith E. Coles (a3) and Gregory P. Strauss (a1)...


Emotion regulation dysfunction is characteristic of psychotic disorders, but little is known about how the use of specific types of emotion regulation strategies differs across phases of psychotic illness. This information is vital for understanding factors contributing to psychosis vulnerability states and developing targeted treatments. Three studies were conducted to examine emotion regulation across phases of psychosis, which included (a) adolescent community members with psychotic-like experiences (PLEs; n = 262) and adolescents without PLEs (n = 1,226); (b) adolescents who met clinical high-risk criteria for a prodromal syndrome (n = 29) and healthy controls (n = 29); and (c) outpatients diagnosed with schizophrenia or schizoaffective disorder (SZ; n = 61) and healthy controls (n = 67). In each study, participants completed the Emotion Regulation Questionnaire and measures of psychiatric symptoms and functional outcome. The three psychosis groups did not differ from each other in reported use of suppression; however, there was evidence for a vulnerability-related, dose-dependent decrease in reappraisal. Across each sample, a lower use of reappraisal was associated with poorer clinical outcomes. Findings indicate that emotion regulation abnormalities occur across a continuum of psychosis vulnerability and represent important targets for intervention.


Corresponding author

Author for correspondence: Gregory P. Strauss, Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA 30602; E-mail:


Hide All
Addington, J., Cadenhead, K. S., Cannon, T. D., Cornblatt, B., McGlashan, T. H., Perkins, D. O., … Heinssen, R. (2007). North American Prodrome Longitudinal Study: A collaborative multisite approach to prodromal schizophrenia research. Schizophrenia Bulletin, 33(3), 665672. doi:10.1093/schbul/sbl075
Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30(2), 217237. doi:10.1016/j.cpr.2009.11.004
Badcock, J. C., Paulik, G., & Maybery, M. T. (2011). The role of emotion regulation in auditory hallucinations. Psychiatry Research, 185(3), 303308. doi:10.1016/j.psychres.2010.07.011
Balzarotti, S., John, O. P., & Gross, J. J. (2010). An Italian adaptation of the Emotion Regulation Questionnaire. European Journal of Psychological Assessment, 26(1), 6167. doi:10.1027/1015-5759/a000009
Cannon, T. D., Cadenhead, K., Cornblatt, B., Woods, S. W., Addington, J., Walker, E., … Heinssen, R. (2008). Prediction of psychosis in youth at high clinical risk: A multisite longitudinal study in North America. Archives of General Psychiatry, 65(1), 2837. doi:10.1001/archgenpsychiatry.2007.3
Cannon, T. D., Yu, C., Addington, J., Bearden, C. E., Cadenhead, K. S., Cornblatt, B. A., … Kattan, M. W. (2016). An individualized risk calculator for research in prodromal psychosis. American Journal of Psychiatry, 173(10), 980988. doi:10.1176/appi.ajp.2016.15070890
Corcoran, C., Walker, E., Huot, R., Mittal, V., Tessner, K., Kestler, L., & Malaspina, D. (2003). The stress cascade and schizophrenia: Etiology and onset. Schizophrenia Bulletin, 29(4), 671692. doi:10.1093/oxfordjournals.schbul.a007038
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2002). Structured Clinical Interview for DSM-IV-TR Axis 1 Disorders—Research Version—Patient Edition (SCID-IV- P). New York: New York State Psychiatric Institute, Biometrics Research Department.
Fresco, D. M., Mennin, D. S., Heimberg, R. G., & Ritter, M. (2013). Emotion regulation therapy for generalized anxiety disorder. Cognitive and Behavioral Practice, 20(3), 282300. doi:10.1016/j.cbpra.2013.02.001
Fusar-Poli, P., Cappucciati, M., Rutigliano, G., Schultze-Lutter, F., Bonoldi, I., Borgwardt, S., … McGuire, P. (2015). At risk or not at risk? A meta-analysis of the prognostic accuracy of psychometric interviews for psychosis prediction. World Psychiatry, 14(3), 322332. doi:10.1002/wps.20250
Fusar-Poli, P., Tantardini, M., De Simone, S., Ramella-Cravaro, V., Oliver, D., Kingdon, J., … Galderisi, S. (2017). Deconstructing vulnerability for psychosis: Meta-analysis of environmental risk factors for psychosis in subjects at ultra high-risk. European Psychiatry, 40, 6575. doi:10.1016/j.eurpsy.2016.09.003
Goodman, R. (1997). The Strengths and Difficulties Questionnaire: A research note. Journal of Child Psychology and Psychiatry, 38(5), 581586. doi:10.1111/j.1469-7610.1997.tb01545.x
Goodman, R. (2001). Psychometric properties of the Strengths and Difficulties Questionnaire. Journal of the American Academy of Child and Adolescent Psychiatry, 40(11), 13371345. doi:10.1097/00004583-200111000-00015
Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85(2), 348362. doi:10.1037/0022-3514.85.2.348
Gullone, E., & Taffe, J. (2011). The Emotion Regulation Questionnaire for Children and Adolescents (ERQ-CA): A psychometric evaluation. Psychological Assessment, 24(2), 409417. doi:10.1037/a0025777
Hawk, A. B., Carpenter, W. J., Strauss, J. S. (1975). Diagnostic criteria and five-year outcome in schizophrenia: A report from the International Pilot Study of Schizophrenia. Archives of General Psychiatry, 32, 343347. doi:10.1001/archpsyc.1975.01760210077005
Henry, J. D., Rendell, P. G., Green, M. J., McDonald, S., & O'Donnell, M. (2008). Emotion regulation in schizophrenia: Affective, social, and clinical correlates of suppression and reappraisal. Journal of Abnormal Psychology, 117(2), 473478. doi:10.1037/0021-843x.117.2.473
Horan, W. P., Hajcak, G., Wynn, J. K., & Green, M. F. (2013). Impaired emotion regulation in schizophrenia: Evidence from event-related potentials. Psychological Medicine, 43(11), 23772391. doi:10.1017/s0033291713000019
John, O. P., & Gross, J. J. (2004). Healthy and unhealthy emotion regulation: Personality processes, individual differences, and life span development. Journal of Personality, 72(6), 13011334. doi:10.1111/j.1467-6494.2004.00298.x
Johns, L. C., & van Os, J. (2001). The continuity of psychotic experiences in the general population. Clinical Psychology Review, 21(8), 11251141. doi:10.1016/S0272-7358(01)00103-9
Kelleher, I., & Cannon, M. (2011). Psychotic-like experiences in the general population: Characterizing a high-risk group for psychosis. Psychological Medicine, 41, 16. doi:10.1017/S0033291710001005
Kimhy, D., Gill, K. E., Brucato, G., Vakhrusheva, J., Arndt, L., Gross, J. J., & Girgis, R. R. (2016). The impact of emotion awareness and regulation on social functioning in individuals at clinical high risk for psychosis. Psychological Medicine, 46(14), 29072918. doi:10.1017/s0033291716000490
Kimhy, D., Vakhrusheva, J., Jobson-Ahmed, L., Tarrier, N., Malaspina, D., & Gross, J. J. (2012). Emotion awareness and regulation in individuals with schizophrenia: Implications for social functioning. Psychiatry Research, 200(2–3), 193201. doi:10.1016/j.psychres.2012.05.029
Kirkpatrick, B., Strauss, G. P., Nguyen, L., Fischer, B. A., Daniel, D. G., Cienfuegos, A., & Marder, S. R. (2011). The Brief Negative Symptom Scale: Psychometric properties. Schizophrenia Bulletin, 37(2), 300305. doi:10.1093/schbul/sbq059
Kline, E., Wilson, C., Ereshefsky, S., Denenny, D., Thompson, E., Pitts, S. C., … Schiffman, J. (2012). Psychosis risk screening in youth: A validation study of three self-report measures of attenuated psychosis symptoms. Schizophrenia Research, 141(1), 7277. doi:10.1016/j.schres.2012.07.022
Linscott, R. J., & van Os, J. (2010). Systematic reviews of categorical versus continuum models in psychosis: Evidence for discontinuous subpopulations underlying a psychometric continuum. Implications for DSM-V, DSM-VI, and DSM-VII. Annual Review of Clinical Psychology, 6, 391419. doi:10.1146/annurev.clinpsy.032408.153506
Livingstone, K., Harper, S., & Gillanders, D. (2009). An exploration of emotion regulation in psychosis. Clinical Psychology and Psychotherapy, 16(5), 418430. doi:10.1002/cpp.635
Martin, R. E., & Ochsner, K. N. (2016). The neuroscience of emotion regulation development: Implications for education. Current Opinion in Behavioral Sciences, 10, 142148. doi:10.1016/j.cobeha.2016.06.006
McGlashan, T., Miller, T. J., Woods, S. W., Hoffman, R. E., Davidson, L. (2001). Instrument for the assessment of prodromal symptoms and states. In Miller, T., Mednick, S. A., McGlashan, T. H., Libiger, J., & Johannessen, J. O. (Series Eds.), NATO Science Series: Vol. 91. Early Intervention in Psychotic Disorders (pp. 135149). doi:10.1007/978-94-010-0892-1_7
McRae, K., Gross, J. J., Weber, J., Robertson, E. R., Sokol-Hessner, P., Ray, R. D., … Ochsner, K. N. (2012). The development of emotion regulation: An fMRI study of cognitive reappraisal in children, adolescents and young adults. Social Cognitive and Affective Neuroscience, 7(1), 1122. doi:10.1093/scan/nsr093
McRae, K., Ochsner, K. N., Mauss, I. B., Gabrieli, J. J. D., & Gross, J. J. (2008). Gender differences in emotion regulation: An fMRI study of cognitive reappraisal. Group Processes and Intergroup Relations, 11(2), 143162. doi:10.1177/1368430207088035
Miller, T. J., McGlashan, T. H., Rosen, J. L., Cadenhead, K., Ventura, J., McFarlane, W., … Woods, S. W. (2003). Prodromal assessment with the Structured Interview for Prodromal Syndromes and the Scale of Prodromal Symptoms: Predictive validity, interrater reliability, and training to reliability. Schizophrenia Bulletin, 29(4), 703715. doi:10.1093/oxfordjournals.schbul.a007040
Miller, T. J., McGlashan, T. H., Woods, S. W., Stein, K., Driesen, N., Corcoran, C. M., … Davidson, L. (1999). Symptom assessment in schizophrenic prodromal states. Psychiatric Quarterly, 70(4), 273287. doi:10.1023/A:1022034115078
Ord, L. M., Myles-Worsley, M., Blailes, F., & Ngiralmau, H. (2004). Screening for prodromal adolescents in an isolated high-risk population. Schizophrenia Research, 71(2–3), 507508. doi:10.1016/j.schres.2004.03.014
Overall, J. E., & Gorham, D. R. (1962). The Brief Psychiatric Scale (BPRS). Psychological Reports, 10, 799812. doi:10.2466/pr0.1962.10.3.799
Pelletier-Baldelli, A., Strauss, G. P., Visser, K. H., & Mittal, V. A. (2017). Initial development and preliminary psychometric properties of the Prodromal Inventory of Negative Symptoms (PINS). Schizophrenia Research, 189, 4349. doi:10.1016/j.schres.2017.01.055
Perry, Y., Henry, J. D., & Grisham, J. R. (2011). The habitual use of emotion regulation strategies in schizophrenia. British Journal of Clinical Psychology, 50(2), 217222. doi:10.1111/j.2044-8260.2010.02001.x
Pfohl, B. M., Blum, N., & Zimmerman, M. (1997). Structured Interview for DSM-IV Personality (SIDP-IV). Washington, DC: American Psychiatric Publishing.
Renna, M. E., Quintero, J. M., Fresco, D. M., & Mennin, D. S. (2017). Emotion regulation therapy: A mechanism-targeted treatment for disorders of distress. Frontiers in Psychology, 8, 98. doi:10.3389/fpsyg.2017.00098
Rosen, J. L., Woods, S. W., Miller, T. J., & McGlashan, T. H. (2002). Prospective observations of emerging psychosis. Journal of Nervous and Mental Disease, 190(3), 133141.
Silvers, J. A., McRae, K., Gabrieli, J. D., Gross, J. J., Remy, K. A., & Ochsner, K. N. (2012). Age-related differences in emotional reactivity, regulation, and rejection sensitivity in adolescence. Emotion, 12(6), 12351247. doi:10.1037/a0028297
Strauss, G. P., & Chapman, H. C. (2018). Preliminary psychometric properties of the brief Negative Symptom Scale in youth at clinical high-risk for psychosis. Schizophrenia Research, 193, 435437.
Strauss, G. P., Kappenman, E. S., Culbreth, A. J., Catalano, L. T., Ossenfort, K. L., Lee, B. G., & Gold, J. M. (2015). Emotion regulation abnormalities in schizophrenia: Directed attention strategies fail to decrease the neurophysiological response to unpleasant stimuli. Journal of Abnormal Psychology, 124(2), 288301. doi:10.1037/abn0000017
Strauss, G. P., Keller, W. R., Buchanan, R. W., Gold, J. M., Fischer, B. A., McMahon, R. P., … Kirkpatrick, B. (2012). Next-generation negative symptom assessment for clinical trials: Validation of the Brief Negative Symptom Scale. Schizophrenia Research, 142(1–3), 8892. doi:10.1016/j.schres.2012.10.012
Strauss, G. P., Raugh, I. M., Mittal, V. A., Gibb, B. E., & Coles, M. E. (2018). Bullying victimization and perpetration in a community sample of youth with psychotic-like experiences. Schizophrenia Research, 195, 534536.
Strauss, G. P., Ruiz, I., Visser, K. H., Crespo, L. P., & Dickinson, E. K. (2018). Diminished hedonic response in neuroleptic-free youth at ultra high-risk for psychosis. Schizophrenia Research: Cognition, 12, 17.
Sullivan, S. K., & Strauss, G. P. (2017). Electrophysiological evidence for detrimental impact of a reappraisal emotion regulation strategy on subsequent cognitive control in schizophrenia. Journal of Abnormal Psychology, 126(5), 679.
Theurel, A., & Gentaz, E. (2018). The regulation of emotions in adolescents: Age differences and emotion-specific patterns. PLoS One, 13(6), e0195501.
van der Meer, L., Swart, M., van der Velde, J., Pijnenborg, G., Wiersma, D., Bruggeman, R., & Aleman, A. (2014). Neural correlates of emotion regulation in patients with schizophrenia and non-affected siblings. PLoS One, 9(6), e99667. doi:10.1371/journal.pone.0099667
van der Meer, L., van't Wout, M., & Aleman, A. (2009). Emotion regulation strategies in patients with schizophrenia. Psychiatry Research, 170(2–3), 108113. doi:10.1016/j.psychres.2009.07.010
Walker, E., Mittal, V., & Tessner, K. (2008). Stress and the hypothalamic pituitary adrenal axis in the developmental course of schizophrenia. Annual Review of Clinical Psychology, 4, 189216. doi:10.1146/annurev.clinpsy.4.022007.141248
Walker, E. F., Trotman, H. D., Pearce, B. D., Addington, J., Cadenhead, K. S., Cornblatt, B. A., … Tsuang, M. T. (2013). Cortisol levels and risk for psychosis: Initial findings from the North American Prodrome Longitudinal Study. Biological Psychiatry, 74(6), 410417. doi:10.1016/j.biopsych.2013.02.016
Yung, A. R., & McGorry, P. D. (1996). The initial prodrome in psychosis: Descriptive and qualitative aspects. Australian and New Zealand Journal of Psychiatry, 30(5), 587599. doi:10.3109/00048679609062654
Yung, A. R., Phillips, L. J., Yuen, H. P., & McGorry, P. D. (2004). Risk factors for psychosis in an ultra high-risk group: Psychopathology and clinical features. Schizophrenia Research, 67(2–3), 131142. doi:10.1016/s0920-9964(03)00192-0


Emotion regulation across the psychosis continuum

  • Hannah C. Chapman (a1), Katherine F. Visser (a1), Vijay A. Mittal (a2), Brandon E. Gibb (a3), Meredith E. Coles (a3) and Gregory P. Strauss (a1)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed