Moderators of emotion regulation abnormalities at the identification, selection, and implementation stages in schizophrenia

Individuals with schizophrenia (SZ) experience difficulties across stages of emotion regulation. However, moderators of abnormalities at each stage have not been systematically examined, limiting the development of mechanism-based treatment approaches. In the current study, outpatients with SZ (n = 52) and healthy controls (CN) (n = 55) completed six days of ecological momentary assessment (EMA) assessing emotional experience, emotion regulation, and moderators including: arousal, emotional awareness, ability to describe emotions, interoception, acceptance, emotion regulation knowledge, and cognitive ability. For identification, emotional awareness and the ability to describe emotions moderated the initiation of emotion regulation in the CN group but not SZ. For selection, interoceptive awareness moderated the frequency of selecting individual strategies in CN only. For implementation, arousal, emotional awareness, and ability to describe emotions improved the effectiveness of down-regulating negative affect in CN but not SZ. Findings suggest that arousal, interoception, emotional awareness, and the ability to describe emotions facilitate emotion regulation processes at the three stages among CN but not SZ. This is consistent with theories positing that SZ engage in contextually insensitive emotion regulation. Findings are discussed in relation to selecting intervention targets tailored to mechanisms underlying abnormalities at each stage of emotion regulation.