The role of emotion regulation in psychosis: understanding the emotion regulation profile of individuals experiencing psychosis and the impact of dialectical behavioural therapy skills training

Abstract

Psychosis is a mental health condition characterized by difficulties in interpreting reality. Current interventions for psychosis primarily focus on management of positive symptoms (i.e. delusions and hallucinations), with unsatisfactory recovery rates. Current research pursing other aspects of this presentation has argued that emotions play a key role in the development and maintenance of psychosis. This highlights the importance of developing an understanding of the emotion regulation profile of individuals experiencing psychosis as a potential intervention focus. A systematic review evaluated 25 studies, published between 2007 and 2018, examining the relationship between emotion regulation and psychosis. A meta-analysis was not possible due to the methodological heterogeneity of the research, and therefore a narrative summary was completed. The review found evidence suggesting that psychosis is associated with difficulties in implementing emotion regulation strategies in a pattern akin to the one exhibited by individuals experiencing mood disorders. However, review of findings across studies is limited by the scarcity of published papers and inconsistent conceptualisation/measurement of emotion regulation within this literature. Suggestions for future research are discussed.

New trans-diagnostic approaches focusing on emotion regulation (i.e. Acceptance and Commitment Therapy, Compassion Focused Therapy) have limited but growing research to suggest they can be effective in decreasing paranoia and negative affect in psychosis. Dialectical Behavioural Therapy (DBT) has been developed with a core focus on developing emotion regulation skills and has an evidence base for a variety of mental health presentations (e.g. borderline personality disorder, addictions, anger, eating disorders). However, it has never been formally researched for the treatment of psychosis. An empirical study was developed to evaluate the impact of DBT informed skills training on individuals experiencing psychosis using a single case series design. Seven participants were recruited from Early Intervention for Psychosis (EIP) and Community Mental Health teams (CMHT) in the south of England. Results indicate that there is an association between emotion regulation skills training and decrease in paranoia and negative affect in psychosis. The results also suggest that individuals in their first years of experiencing psychosis are more responsive to learning emotion regulation skills. Collectively, the findings from this study support the importance of understanding emotion regulation in individuals experiencing psychosis.

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ORCID for Katherine Newman-Taylor: orcid.org/0000-0003-1579-7959

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