Emotion dysregulation in schizophrenia: Reduced amplification of emotional expression is associated with emotional blunting

Abstract

A prominent emotional disturbance in schizophrenia is clinically evident in blunted affect, often observed as reduced emotional expressivity alongside the individual's report of normal or heightened emotional experience. It has been suggested that this disjunction between the experience and expression of emotion may reflect problems with the regulation of emotional expression. The present study thus set out to examine the capacity to engage in particular emotion regulatory strategies, and specifically, the ability to amplify the emotional expression of an experienced emotion (‘amplification’) or suppress the emotional expression of an experienced emotion (‘suppression’) whilst watching film clips selected to elicit amusement. Twenty nine participants with schizophrenia and 30 demographically matched non-clinical controls were asked to watch three different amusing film clips, whilst engaging in different regulatory strategies. The results indicate that participants with schizophrenia have difficulties with the amplification (but not suppression) of emotion expressive behavior. These difficulties are significantly correlated with total negative symptoms experienced, particularly 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.