Emotion Regulation Mechanisms in Schizophrenia Spectrum Disorders

Schizophrenia spectrum disorders are characterised by profound disruptions in the capacity to modulate emotional responses, with implications for symptom severity, social functioning and therapeutic outcomes. Emotion regulation—the processes by which individuals influence which emotions they experience, when they experience them and how they express them—often reveals maladaptive patterns in psychosis. Neuroimaging studies have identified altered prefrontal–limbic dynamics, including reduced ventrolateral prefrontal activation and weakened inverse coupling with the amygdala during attempts to downregulate negative affect. Behavioural research documents a reliance on suppression and experiential avoidance alongside diminished use of adaptive strategies such as cognitive reappraisal and acceptance. These regulatory disturbances interact with core features of the disorder: excessive suppression and poor emotional awareness can amplify hallucinations and delusional ideation, while impaired anticipation and maintenance of positive emotions contribute to social withdrawal and motivational deficits. Experience sampling studies highlight that momentary regulatory choices forecast fluctuations in psychotic symptoms, and that enhanced emotion awareness may mitigate these effects. Collectively, these findings delineate a multifaceted profile of emotion regulation abnormalities in schizophrenia spectrum disorders, spanning neural substrates, daily‐life processes and targets for intervention.

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Emotion Regulation Mechanisms in Schizophrenia Spectrum Disorders publication trend

The graph below shows the total number of articles in emotion regulation mechanisms in schizophrenia spectrum disorders across all publications each year (not limited to Nature Index journals).

Technical terms

Emotion regulation: The set of processes involved in monitoring, evaluating and modifying emotional reactions to achieve personal goals.

Cognitive reappraisal: A strategy that involves altering one’s interpretation of an emotional event to change its emotional impact.

Expressive suppression: The conscious inhibition of outward signs of inner feelings during emotional arousal.

Alexithymia: A trait characterised by difficulty in identifying, describing and differentiating one’s own emotions.

Effort‐based decision‐making: A model positing that individuals weigh anticipated effort costs against potential rewards when choosing whether to undertake an action.

References

1. Lack of cortico-limbic coupling in bipolar disorder and schizophrenia during emotion regulation. Translational Psychiatry (2012).
2. Cognitive emotion regulation strategies, alexithymia and dissociation in schizophrenia, a review and meta-analysis. Clinical Psychology Review (2014).
3. Social cognition and social motivation in schizophrenia and bipolar disorder: are impairments linked to the disorder or to being socially isolated?. Psychological Medicine (2024).
4. Social Motivation in Schizophrenia: What’s Effort Got to Do With It?. Schizophrenia Bulletin (2023).
5. The impact of emotion awareness and regulation on psychotic symptoms during daily functioning. Schizophrenia (2020).