Emotion dysregulation in schizophrenia: Reduced amplification of emotional expression is associated with emotional blunting
Introduction
Abnormalities in the experience, expression, and recognition of affect are well documented in schizophrenia (Aleman and Kahn, 2005, Ellgring and Smith, 1998), and substantially reduce the potential for effective vocational and interpersonal functioning (Aghevli et al., 2003). The most prominent of these emotional abnormalities is evident clinically as blunted affect, characterized by markedly reduced emotional expressivity, alongside apparently normal emotional experiences (Berenbaum and Oltmanns, 1992, Kirkpatrick and Fischer, 2006). Blunted affect is observed from the earliest stages of illness, and often continues in chronic stages following the amelioration of active psychotic symptoms with psychopharmacological treatment (Gur et al., 2006). Blunted affect in schizophrenia has been particularly linked to social behavioral abnormalities, and predicts poor outcome (Dworkin et al., 1998).
It has recently been proposed that the disjunction between experience and expression of affect that characterizes blunted affect may be attributable to emotion dysregulation. In a prominent theoretical account of emotion regulation Gross (2001, 2007) argues that response-focused emotion regulatory strategies occur after the emotion response has been triggered, and require management of the ongoing emotional experience, expression and physiological responses. Typical examples include suppression (the conscious inhibition of ongoing emotion-expressive behavior) and amplification, (the behavioral augmentation of an already initiated emotion; see Denmaree et al., 2004, Gross, 2001). One hypothesis is that blunted affect may reflect abnormal suppression of emotional responses that otherwise cause excessive load upon an overly sensitive physiological system (Ellgring and Smith, 1998). However, Kring and Werner (2004) argue that suppression of expressive behavior is usually associated with increased autonomic nervous system activity. Although patients with schizophrenia have demonstrated greater skin conductance reactivity to emotional films, despite being less facially expressive and experiencing comparable levels of emotion relative to healthy controls, increased physiological activity is also observed in response to neutral films (Kring and Neale, 1996). This pattern of findings is therefore inconsistent with the argument that over-use of suppression may be responsible for the disjunction between affective experience and behavior. Kring and Werner (2004) have suggested instead that the discrepancy may be attributable to impaired up-regulation of emotional expression.
The present study will be the first to directly investigate whether individuals with schizophrenia are impaired in their capacity to suppress (down-regulate) or amplify (up-regulate) expressive emotional behavior. Whilst the modulation of both positive and negative emotion expression behavior is clearly of enormous adaptive significance (Gross and Levenson, 1997), given that anhedonia (the decreased capacity to experience pleasure, in both physical and social–interpersonal domains) is regarded as a core feature of schizophrenia, the present study focused on capacity to up- and down-regulate positive emotion expressive behavior, and specifically, amusement. It is predicted that whilst the ability to down-regulate (suppress) emotional reactions to positive emotional events will be spared in schizophrenia, the ability to up-regulate (amplify) emotional experience will be disrupted. It is further predicted that difficulties with amplification will be related to emotional blunting.
Section snippets
Method
All procedures were approved by the Human Research Ethics Committee of the South Eastern Sydney Area Health Service.
Results
Self-report amusement data are presented in Table 1. Data related to self-report in the experimental conditions were analyzed with a 1 × 3 mixed ANOVA design, with the between subjects variable of schizophrenia status and the within subjects variable of emotion regulation condition (expression, suppression, amplification). These two variables did not significantly interact (p > .05), and there was no significant main effect of emotion regulation condition, indicating that level of reported
Discussion
The present results indicated that both schizophrenia and control participants were able to effectively implement the strategy of suppression. In contrast, during the amplification condition, only control (but not schizophrenia) participants were able to exaggerate their behavioral response. It is important to note that these findings were demonstrated both via between- and within-group analyses. Thus, relative to their own behavioral responses in the baseline (expression) condition,
Role of the Funding Source
Funding for this study was provided by an Australia Research Council grant awarded to Henry and McDonald (DP0663182). The Australian Research Council had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.
Contributors
Julie Henry designed the study, conducted the statistical analyses and wrote the first draft of the manuscript. Melissa Green assisted with conceptual issues related to the study design, and also made a substantial contribution in writing the manuscript. Amber de Lucia and Corinne Restuccia recruited participants and conducted the experimental testing. Skye McDonald assisted with conceptual issues related to the study design. Maryanne O'Donnell assisted with participant recruitment. All authors
Conflict of Interest
There are no actual or potential conflicts of interests with respect to the authors' involvement in this manuscript.
Acknowledgement
The authors acknowledge the Research Register of the Schizophrenia Research Institute, Australia, for assisting with the recruitment of the volunteers participating in this research, as well as the participants themselves.
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