Emotion Dysregulation Mediates the Effects of Trauma on Depression, Positive Symptoms in Psychosis


Emotion dysregulation may mediate the effects of severe trauma on the symptoms of early nonaffective psychosis, according to study data published in Schizophrenia Research. In a cohort study, maladaptive cognitive emotion regulation and global emotion dysregulation emerged as mediators of the effects of trauma on depressive and positive symptoms in early nonaffective psychosis. 

Although trauma may play a role in the symptoms of psychosis, few studies have examined the potential mediating effects of emotion dysregulation. This study sought to investigate the impact of maladaptive emotion regulation following severe trauma. Investigators recruited outpatients with a clinical diagnosis of early nonaffective psychosis from a tertiary psychiatric hospital in Singapore. They determined demographic and clinical characteristics through a self-report questionnaire.

Trauma exposure was assessed using the Stressful Life Event Questionnaire. Maladaptive cognitive emotion regulation strategies, measured with the Cognitive Emotion Regulation Questionnaire, included rumination, catastrophic thinking, and self-blame. Emotion dysregulation was measured using the Difficulties with Emotion Regulation Scale. Patients were also tested for posttraumatic stress disorder (PTSD), current depressive, and positive psychotic symptoms.

Using least squares regression, 2 hypothesized mediation models were constructed, adjusted for gender, psychiatric comorbidities, antipsychotic medication dosage, duration of untreated psychosis, family history of mental illness, and cumulative trauma. Model 1 assessed maladaptive cognitive emotion regulation strategies and global emotion dysregulation as parallel mediators of the relationship between PTSD and depressive symptoms. Model 2 extended this analysis to include positive symptoms of psychosis.

The cohort comprised 150 patients (mean age 26.5±6.20 years; 56.7% men); the majority of patients were Chinese (67.3%)­. Maladaptive cognitive emotion regulation strategies and global emotion dysregulation were mediators of the effects of PTSD on depression symptoms (b, 1.47; SE, 0.51; 95% CI, 0.63-2.61). In Model 2, maladaptive cognitive emotion regulation strategies, global emotion dysregulation, and depression mediated the effect of PTSD on positive symptoms (b, 1.08; SE, 0.43; 95% CI, 0.30-2.01).

These mediators functioned together; alone, cognitive emotion regulation strategies, global emotion dysregulation, and depression were not significant mediators of the relationship between PTSD and positive symptoms. Model 1 accounted for 41% of the variance in depressive symptoms; Model 2 accounted for 30% of the variance in current positive symptoms.

As a limitation, investigators noted the reliance on self-report measures. “Emotion dysregulation may be a potential transdiagnostic treatment target to alleviate depressive and positive symptoms in traumatized patients with early non-affective psychosis,” the investigators wrote.

Reference

Liu J, Lim MSM, Ng BT, Chong SA, Subramaniam M, Mahendran R. Global emotion dysregulation and maladaptive cognitive emotion regulation strategies mediate the effects of severe trauma on depressive and positive symptoms in early non-affective psychosis [published online May 27, 2020]. Schizophr Res. doi: 10.1016/j.schres.2020.05.040



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