Adaptive Associations between Social Cognition and Emotion Regulation are Absent in Schizophrenia and Bipolar Disorder.

0.57 MB·English

by  Rowland, Jesseca E.

ORIGINALRESEARCHARTICLE
published:11January2013
doi:10.3389/fpsyg.2012.00607
Adaptive associations between social cognition and
emotion regulation are absent in schizophrenia and bipolar
disorder
JessecaE.Rowland1,MeelahK.Hamilton1†,NicholasVella1,BiancaJ.Lino1,PhilipB.Mitchell1,2 and
MelissaJ.Green1,2,3*
1SchoolofPsychiatry,UniversityofNewSouthWales,Sydney,NSW,Australia
2BlackDogInstitute,PrinceofWalesHospital,Randwick,NSW,Australia
3SchizophreniaResearchInstitute,Darlinghurst,NSW,Australia
Editedby: Schizophrenia(SZ)andbipolardisorder(BD)areassociatedwithimpairmentsinfacialemo-
UllrichWagner,Charité–University tion perception andTheory of Mind (ToM).These social cognitive skills deficits may be
MedicineBerlin,Germany
relatedtoareducedcapacitytoeffectivelyregulateone’sownemotionsaccordingtothe
Reviewedby:
socialcontext.Wethereforesetouttoexaminetherelationshipbetweensocialcognitive
MauroAdenzato,UniversityofTurin,
Italy abilitiesandtheuseofcognitivestrategiesforregulatingnegativeemotioninSZandBD.
FrankSchneider,UniversityHospital Participantswere56SZ,33BD,and58healthycontrols(HC)whocompletedtheEkman60-
Aachen,Germany facestestoffacialemotionrecognition;asub-setoftheseparticipantsalsocompletedThe
*Correspondence: Awareness of Social InferenceTest (TASIT) and the Cognitive Emotion Regulation Ques-
MelissaJ.Green,UniversityofNew
tionnaire (CERQ). SZ participants demonstrated impairments in emotion perception on
SouthWalesResearchUnitfor
SchizophreniaEpidemiology,O’Brien boththeEkmanandtheTASITEmotionEvaluationtestsrelativetoBDandHC.Whileboth
Centre,St.Vincent’sHospital,Level4, SZ and BD patients showedToM deficits (i.e., perception of sarcasm and lie) compared
394–404VictoriaStreet,Darlinghurst, to HC, SZ patients demonstrated significantly greaterToM impairment compared to BD.
NSW2010,Australia.
Therewerealsodistinctpatternsofcognitivestrategiesusedtoregulateemotioninboth
e-mail:[email protected]
patientgroups:thosewithSZweremorelikelytoengageincatastrophizingandrumination,
†MeelahK.Hamiltonisdeceased.
whileBDsubjectsweremorelikelytoblamethemselvesandwerelesslikelytoengage
inpositivereappraisal,relativetoHC.Inaddition,thosewithSZweremorelikelytoblame
otherscomparedtoBD.Associationsbetweensocialcognitionandaffectregulationwere
revealed for HC only:TASIT performance was negatively associated with more frequent
use of rumination, catastrophizing, and blaming others, such that more frequent use of
maladaptivecognitiveemotionregulationstrategieswasassociatedwithpoorsocialcog-
nitiveperformance.Theseassociationswerenotpresentineitherpatientgroup.However,
bothSZandBDpatientsdemonstratedpoorToMperformanceandaberrantuseofemo-
tionregulationstrategiesconsistentwithpreviousstudies.SZalsoshowedbasicemotion
recognitiondeficitsrelativetoBDandHC.Thattherewerenoassociationsbetweensocial
cognitionandthecapacitytoself-regulatenegativeemotioninSZandBD(inthecontext
ofpoorsocialcognitionandmaladaptiveregulatorystrategies)suggeststhatdysfunction
infronto-limbicbrainnetworksmayunderpinbothsocialcognitivedeficitsandtheuseof
maladaptivecognitivestrategiesinthesedisorders,albeitbypotentiallydifferentroutes.
Keywords:socialcognition,emotion,cognitiveemotionregulation,schizophrenia,bipolardisorder
INTRODUCTION (Malhietal.,2004a,b),overtmanifestationsofemotionalityinSZ
Despite their traditional conceptualization as separate diagnos- are often characterized by inappropriate or blunted affect, that
ticentities,thereisgrowingrecognitionofoverlappingpathology is,lackofcontext-appropriateemotionalexpressivity(Guretal.,
between schizophrenia (SZ) and bipolar disorder (BD), evident 2006).
in shared clinical features (Murray et al., 2004), neurocognitive Uniquedysfunctioninthebrainnetworksrequiredforthevol-
(Reichenbergetal.,2009;Boraetal.,2010),socialcognitivedeficits untaryregulationofemotioninBDandSZ(Morrisetal.,2012)
(Montagetal.,2010;Sparksetal.,2010),andgeneticdeterminants suggestthatthesharedtendencytoimplementmaladaptive reg-
(Lichtensteinetal.,2009).However,thereremainobviouspoints ulatory styles (Rowland et al., in revision) may reflect distinct
ofdepartureintheclinicalpathologyofSZandBD,mostnotably fronto-limbicbrainnetworkabnormalities.Specifically,Morriset
intheovertexpressionofaffect.Thatis,whileBDischaracterized al.foundthatpatientswithBDdemonstratedincreasedbutappar-
bydisturbanceof moodreflectedinmanicanddepressivestates ently ineffectual cortical activation during attempts to regulate
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Rowlandetal. Emotionregulationinpsychosis
negativeemotion,whileSZpatientsgenerallyfailedtoengagecor- reported (Yurgelun-Todd et al.,2000; Lembke and Ketter,2002;
ticalregionsduringattemptstodown-regulatenegativeemotion. Samame et al., 2012), although these findings are inconsistent
Inthecontextofestablishedbrainmechanismsresponsibleforthe (Malhietal.,2007).Inthisstudy,theEkman60-facestaskfromthe
regulationofaffect(Ochsneretal.,2004),itispossiblethatcom- FacialExpressionsofEmotion:StimuliandTests(FEEST;Young
mon cognitive deficits in SZ and BD (predominantly reflecting etal.,2002)waschosenasawell-validatedfacialaffectprocessing
prefrontalcorticalbraindysfunction)couldimpedethecapacity taskthatrequiresparticipantstoidentifybasicemotionsfroma
foreffectiveself-regulationofemotioninthesedisorders(Green seriesoffacespresentedinastillphotographicformat.
etal.,2007).Forinstance,areviewbyOchsnerandGross(2008) Staticphotographs,however,aremarkedlydifferenttosponta-
highlightsamodelofbrainnetworkssupportingcognitiveemo- neousdynamicdisplaysofemotionthatmustberapidlydecoded
tionregulationwherecognitivestrategiesvaryintheirrelianceon ineverydaysocialsituationswhereemotionsaredisplayedbriefly
prefrontalandcingulatesystemsforattention,response-selection, and quickly. The Awareness of Social Inference Test (TASIT;
and mental-state attribution. These same deficits in executive McDonald et al.,2003) addresses this issue by using videotaped
function have been shown to influence mentalizing ability and footageoftrainedactorsindynamicdisplaysofemotion,aswell
facialaffectprocessinginSZandBD(AddingtonandAddington, asinconversationalinteractionswithothers,requiringtheinte-
1998;Boraetal.,2005;Olleyetal.,2005),suchthatthereispoten- gration of multiple, changing cues (from face, prosody, gesture
tialforsocialcognitivedeficitstoalsoimpactemotionregulation and context) to identify the emotions,beliefs,and intentions of
capacitiesintheseclinicalgroups(Ochsner,2008;Phillipsetal., targetcharacterswithinthesocialcontext.TheTASITthuspro-
2008).Inthisstudyweaimedtoaddressthisquestioninthecon- videsanecologicallyvalidmeasureofsocialcognitionthatassesses
textof knownaberrationsinbothsocialcognitionandemotion bothsimple(basicemotionperception)andcomplex(ToMskills)
regulationinthesedisorders. socialcognition,withhigherlevelsofdifficultyrequiringtheinte-
Social cognition is a domain of cognitive processing which grationofcontextualcuesandtheperceptionofliesandsarcasm.
involves all of the processes necessary for interacting with con- Sarcasmisoneexampleof anon-literallanguagedeviceusedin
specifics(Adolphs,2004),andencompassestwoimportantskills: conversation that relies on ToM,since the true state of affairs is
(1)theabilitytoaccuratelyperceiveemotionalinformationfrom theoppositetothatassertedintheliteralutterance(Brownand
others(e.g.,fromfacialexpressionsandvocalinflections);and(2) Levinson,1978;Haverkate,1990).RecentstudiesusingtheTASIT
theabilitytomakehigherordersocialinferencesabouttheinten- demonstrateimpairmentsofsarcasmperceptioninSZ(Leitman
tionsandbehaviorofothers,oftenreferredtoasTheoryofMind et al., 2006; Kern et al., 2009; Sparks et al., 2010), while stud-
(ToM;Pinkhametal.,2003).Effectivesocialcognitiveprocessesare iesofToMdeficitsusingmoretraditionalpicture-storytaskshave
requiredtorespondappropriatelyinsocialinteractions(McDon- repeatedlydemonstratedToMimpairmentsinschizophrenicindi-
aldetal.,2003).Disruptedsocialcognitionisfrequentlyobserved viduals(Brune,2005;Harringtonetal.,2005).Again,thesedeficits
inSZ(Brune,2005),withaconsiderablebodyofresearchdemon- havebeenshowntopersistwhenpatientsareinremission(Sprong
strating impairments in the perception of facial affect (Mandal etal.,2007).MountingevidencealsoindicatesthatBDpatientsare
etal.,1998;Edwardsetal.,2002;Namikietal.,2007;Kohleretal., impairedintheirabilityto“mentalize”:BDpatientsinanaffec-
2010;Sparksetal.,2010)andemotionalprosody(Leitman,2005; tivestate(depressedormanic)havebeenfoundtoperformworse
Hoekertetal.,2007).Therehasbeensomeevidencetosuggestthat on ToM tasks than euthymic BD patients who had comparable
SZ patients have more difficulty interpreting negative emotions resultstocontrols(Kerretal.,2003).However,otherstudieshave
(suchassadnessanddisgust)comparedtopositiveemotions(such reportedimpairedToMineuthymicBDaswell(Boraetal.,2005;
ashappiness;Edwardsetal.,2002).Abiastomisinterpret“neutral” Montagetal.,2010).
facesas“sad,”“happy,”or“disgusted”hasalsobeendemonstrated Thepropensityforsocialcognitivedeficitstoimpactemotion
(Kohleretal.,2003).Furthermore,theseimpairmentshavebeen regulation is supported by current knowledge of the cognitive
showntopersistduringremissionof psychoticsymptoms(Kern and neural mechanisms for emotion generation and regulation
etal.,2009).Similarly,studiesof BDrevealthatbipolarpatients (GreenandMalhi,2006).Specifically,emotionregulationrefersto
arealsoimpairedontasksoffacialaffectperceptioncomparedto arangeofvoluntaryandinvoluntaryprocessesusedtomodulate
healthycontrols(HC),butdonotperformaspoorlyasSZpatients the occurrence,intensity,and duration of internal feeling states
(AddingtonandAddington,1998).Indeed,meta-analysesofemo- andphysiologicalprocessesthatoccurinrelationshiptoexternal
tionperceptioninbothpatientgroupshaverevealedalargedeficit events, in order to respond appropriately in accord with one’s
forSZ(Kohleretal.,2010)comparedtoamoderatedeficitforBD goals (Gross, 1998; Eisenberg, 2000). Emotional responses are
(Kohleretal.,2011). refinedthroughacomplexinteractionbetweenprimitivelimbic
Interestingly,manystudiessuggestthatmood-congruentbiases structures(engagedintheperceptionandgenerationofemotion)
in emotion perception may be operating in BD. For example,a and cortical regions (engaged in inhibitory control of affective
“negative bias”has been found in BD during a depressed state, responses) to provide flexibility in response to changes in both
where there is a tendency to rate “neutral” faces as “sad” and internal and external environments (Green and Malhi, 2006).
“happy” faces as “neutral” (Gur et al., 1992; Gray et al., 2006). Commonstrategiestoregulatesubjectiveaffectincludeattempts
Comparable research during mania suggests a “positive bias” tocognitivelycontrolthetypeandextentof emotionalresponse
in which“neutral”facial expressions are interpreted as“happy” via techniques to reframe the meaning of the event (Ochsner
(Lennoxetal.,2004).Furthermore,thepersistenceofsocialcog- and Gross, 2005); cognitive reappraisal is one such technique
nitiveimpairmentsintotheeuthymicphaseofBDhasalsobeen that involves reappraisal of emotional and social information
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Rowlandetal. Emotionregulationinpsychosis
to modulate one’s own emotional responses (Green and Malhi, regulatingnegativeemotioninSZandBD.Thefollowinghypothe-
2006). ses were tested on the basis of evidence reviewed above. First,
Cognitivereappraisalrequireseffectiveinhibitionofthelimbic we hypothesized that SZ and BD participants would both be
system by prefrontal brain regions,specifically the orbitofrontal impaired on the Ekman 60-faces task and TASIT emotion per-
cortex(OFC),dorsolateralprefrontalcortex(DLPFC),lateralpre- ceptionrelativetocontrols,butwithSZpatientsshowinggreater
frontalcortex(LPFC),andmedialprefrontalcortex(MPFC;Green impairment than those with BD. Second, it was hypothesized
andMalhi,2006),suchthatknownabnormalitiesinneurocogni- that both SZ and BD participants would be impaired on TASIT
tiveandsocialcognitivedeficitsinSZandBDarethereforelikely social inference tests relative to controls, with SZ participants
toimpactmechanismsforemotionregulation. again demonstrating greater impairments compared to BD par-
Forinstance,workingmemorydeficitsinSZandBDhavealso ticipants.Third,wehypothesizedthatSZandBDgroupswould
been associated with abnormal brain activity in the OFC and be more likely to use maladaptive cognitive emotion regula-
DLPFC (Park et al., 1999), and evidence has shown that social tion strategies (i.e., increased rumination, catastrophizing, and
cognitiveskillsarepartiallyaccountedforbynon-socialneurocog- self-blame) and less likely to use adaptive positive reframing
nitivecapacities(Sergietal.,2007),particularlythoseassociated strategies (e.g., positive reappraisal) in comparison to controls.
with prefrontal cortical function (Crowe et al., 1999). Further- Lastly, we hypothesized that performance on the social cogni-
more,neuroimaging studies of social cognition in patients with tion tasks would be associated with the use of particular CERQ
mooddisordershaverevealedenhancedactivationinlimbicstruc- strategiesintheSZandBDgroups;specifically,thatpoorerper-
turesandattenuatedactivitywithinfrontalregionsassociatedwith formance on the Ekman task and TASIT would be associated
emotion regulation (Cusi et al.,2012). Indeed,we have recently with increased use of maladaptive emotion regulation strate-
demonstrateddistinctaberrationsinprefrontal-limbicbrainnet- gies (rumination, self-blame, other-blame, and catastrophizing)
worksinSZandBDduringattemptstodown-regulatenegative anddecreaseduseof adaptivereframingstrategies(e.g.,positive
affectusingcognitivereappraisal(Morrisetal.,2012),Inaddition, reappraisal).
emergingevidencesuggeststhat“exhaustion”of theseinhibitory
regions can result in over-activation of the amygdala,alongside MATERIALSANDMETHODS
aberrant connectivity of PFC-amygdala networks (Wagner and StudyprocedureswereapprovedbytheHumanResearchEthics
Heatherton,2012).Thesebraindisturbancesinnetworksrequired CommitteesoftheUniversityofNewSouthWales(HRECUNSW
forefficientemotionregulationmayexplainwhyindividualswith ProtocolNo.07167)andtheSouthEasternSydneyIllawarraArea
a history of psychosis demonstrate less frequent use of cogni- Health Service (SESIAHS Protocol No. 09/081).All participants
tivereappraisalrelativetonon-patientcontrols(Livingstoneetal., providedwritteninformedconsentpriortoparticipation.
2009).Furthermore,withovertsignsofdysregulatedemotionin
SZ most commonly seen in blunted affect, it is not surprising PARTICIPANTS
thatattenuatedaffectinSZhasbeenassociatedwithdifficultiesin Thesamplecomprised56participantswithSZ,33withbipolarI
theamplification(up-regulation)ofpositiveemotionalexpression disorder,and58HCwhocompletedtheEkmantask;withasub-
(Henryetal.,2007). setof47SZ,27BD,and47HCcompletingtheTASIT.Ofthese,32
Direct comparison of SZ and BD with regard to cognitive SZ,24BD,and36HCcompletedtheCERQ.Allsubjectsfulfilled
processesusedtoregulateemotionhasbeenrecentlyundertaken relevant DSM-IV criteria. Healthy participants had no personal
inalargesampleofoutpatientsassessedwiththeCognitiveReg- historyofaDSM-IVAxis1disorderotherthananxietydisorders,
ulation of Emotion Questionnaire (CERQ; Rowland et al., in andnohistoryofpsychosis(SZorBD)intheirfirst-degreebiolog-
revision). This study revealed a pattern of similarly increased icalrelatives.Exclusioncriteriaincludedinabilitytocommunicate
tendencies to employ rumination, self-blame, and catastrophiz- sufficientlyinEnglish,currentneurologicaldisorderand/orhaving
ing evident among SZ and BD, alongside distinct use of other- beentreatedwithelectroconvulsivetherapy(ECT)intheprevious
blameinSZ(Rowlandetal.,inrevision).TheCERQ(Garnefski 6months.
et al., 2001) provides an index of the extent to which particu- Participantswererecruitedfromanumberofsources,includ-
lar cognitive strategies are employed to regulate negative emo- ing theAustralian Schizophrenia Research Bank (ASRB;Lough-
tion in response to threatening or stressful life events. Previous land et al., 2011), the Sydney Bipolar Disorder Clinic (Mitchell
researchusingthisscalehasshownincreaseduseofrumination, et al., 2009), and advertisements in the local community and
catastrophizing, and self-blame, coupled with decreased use of newspaper.TheSZgroupconsistedof 32males(57.1%)and24
adaptivecognitivereframingstrategies(forexample,positivereap- females(42.9%),aged19–63years(M=44.57,SD=10.37).The
praisal), in association with depression and anxiety symptoms BDgroupcomprised18males(54.3%)and15females(45.7%),
(Garnefski et al.,2001,2002,2005; Garnefski and Kraaij,2006). aged22–60years(M=40.67,SD=11.27).Atthetimeofassess-
A similar pattern of responses on the CERQ has also recently ment,12BDparticipantsweredeterminedeuthymic(36.4%),12
emergedforBDpatientsandtheirunaffectedrelatives(Greenetal., hypomanic (36.4%), 1 depressed (3%), and 8 in a mixed state
2011). (24.2%).TheHCparticipantswereequallydividedbetweenmales
On the basis of likely inter-relationships among social cog- andfemalesandaged19–61years(M=33.91,SD=12.24).There
nitive ability and emotion regulatory capacities,we set out here weremissingdataonlessthan10%ofitemsforsevenclinicalpar-
to examine the relationship between both emotion perception ticipants;missingdatawerereplacedwiththegroupmedianfor
and ToM disturbances and the use of cognitive strategies for eachitem.
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Rowlandetal. Emotionregulationinpsychosis
AnumberofSZandBDparticipantswereprescribedantipsy- Part 2: Social Inference – Minimal is comprised of 15 video
chotic,antidepressant,ormoodstabilizingmedicationatthetime clips depicting sincere and sarcastic (simple sarcasm and para-
oftesting.OftheSZpatients,18weretakinganantipsychotic,18 doxicalsarcasm)interactionbetweentwoactors,thusexamining
anantipsychoticandantidepressant,5anantipsychoticandmood ToM.Thedialogusedisambiguous,requiringattendancetogen-
stabilizer,and7anantipsychoticandantidepressantplusamood eraldemeanor,toneof voice,facialexpressions,and/orgestures,
stabilizer.OftheBDparticipants,2weretakinganantipsychotic, inordertointerpretthesituation.Insincereexchanges,thetarget
7amoodstabilizer,10anantipsychoticandamoodstabilizer,7 actorsmeanwhattheysay.Insimplesarcasmexchanges,oneof
anantidepressantandmoodstabilizer,and2weretakingallthree. thetargetactorsmeanstheoppositeofwhatissaid,andintends
Theremainingpatientswerenotcurrentlytakinganymedication. forthelistenertocomprehendtherealmeaningof whatissaid.
Inparadoxicalsarcasmexchanges,thedialogbetweenspeakersis
nonsensicalunlessitisunderstoodthatonespeakerisbeingsar-
MATERIALS
InternalStateScale castic.Attheendofeachclip,participantsansweredfourquestions
MoodstateoftheBDparticipantsatthetimeofassessmentwas designedtoelicitinterpretationsof whatthespeakerwasthink-
indexedbytheInternalStateScale(ISS;Baueretal.,1991)TheISS ing,doing(e.g.,criticizing),meaningtosay,andfeeling.Aseach
isa16-itemself-reportscalethatprovidesanindexofmanicand ofthe15videoclipsisgivenascoreoutof4,themaximumscore
depressivesymptomatologyforthepreceding24h.Themeasure attainableinthispartis60.
isdividedintofoursubscales:Activation,PerceivedConflict,Well- Part3:SocialInference–Enriched,whichalsoexaminesToM,is
Being,andaDepressionIndex.Eachitemisratedona100-point comprisedof16vignettesforwhichparticipantsareprovidedextra
visualanalogscaleanchoredat0and100,witheachanchorincor- informationaboutthetruestateofaffairsbeforeorafterthedialog
porating both the frequency and severity of the symptom. The ofinterest.Participantsanswerfourquestionsdesignedtoexam-
Activation subscale items correspond to manic symptoms (e.g., inetheirabilitytodetectdeceptioninsocialencounters(i.e.,lies)
“Mythoughtsaregoingfast),andtheDepressionIndextodepres- andsarcasm.Themaximumattainablescoreinthissectionis64.
sivesymptoms(e.g.,“Itseemslikenothingwillworkoutforme”),
andtheyhavebeenfoundtocorrelatehighlywithclinicianratings CognitiveEmotionRegulationQuestionnaire
ofmaniaanddepression,respectively. TheCognitiveEmotionRegulationQuestionnaire(CERQ)mea-
sures various types of cognitive strategies employed to regulate
emotioninresponsetotheexperienceofthreateningorstressful
PositiveandNegativeSyndromeScale
lifeevents(Garnefskietal.,2001).TheCERQisa36-itemques-
CurrentsymptomsofSZandBDpatientswereassessedusingthe
tionnaire,consistingofnineconceptuallydistinctsubscales(four
PositiveandNegativeSyndromeScale(PANSS;Kayetal.,1987).
items each), each pertaining to a particular type of regulatory
ThePANSShasthreesubscales,positivesymptoms,negativesymp-
strategy.A person’s tendency to engage in each strategy is mea-
toms,andgeneralpsychopathology.Eachsymptomreceivesarating
suredonafive-pointLikertscalerangingfrom1(almostnever)
between1(Absent)and5(Severe).
to 5 (almost always). Individual subscale scores are obtained by
summingthescoresforeachstrategy(rangingfrom4to20);the
Ekman60-facestaskfromtheFacialExpressionsofEmotion:Stimuli higher the subscale score, the more often the cognitive strategy
andTests is used. The four maladaptive subscales of the CERQ include:
Asameasureofemotionperception,subjectswereadministered self-blame(thoughtsofblamingyourselfforwhatyouhaveexpe-
the Ekman 60-faces task from the FEEST (Young et al., 2002). rienced), other-blame (thoughts of blaming another person for
FEESTisacomputerizedtask,whereparticipantsarerequiredto whatyouhaveexperienced),rumination(thinkingaboutfeelings
identify six basic emotions from the Ekman and Friesen (1976) and thoughts associated with the negative event), and catastro-
series(happiness,sadness,anger,fear,surprise,anddisgust)pre- phizing (thoughtsthatover-emphasizethesignificanceandextent
sentedinastill“photographic”format.Inaccordancewithprevi- oftheexperience).Thefivepositivesubscalesinclude:puttinginto
ousresearchofemotionrecognition,happinessandsurprisewere perspective (thoughtsthatminimizetheseriousnessof theevent
considered “positive” expressions, and sadness, anger, fear, and relativetootherlifeevents),positiverefocusing(distractingoneself
disgustwereconsidered“negative”expressions. from thinking about the event by focusing on positive thoughts
or issues),positive reappraisal (reframing the event in a positive
TheAwarenessofSocialInferenceTest light),acceptance (acceptingtheexperienceandresigningoneself
AllsubjectscompletedFormAofTASIT(McDonaldetal.,2003) towhathashappened),andrefocusonplanning (thinkingabout
to index emotion perception and ToM abilities. TASIT com- howtohandlethenegativeeventandwhatstepstotake).Internal
prisesthreeparts,asdetailedbelow,andanadministrationtime consistencies of CERQ subscales range from 0.68 to 0.83 (Gar-
of approximately 35min. Practice items were provided for all nefskietal.,2001),andevidencefordiscriminantandconvergent
parts,andthevideotapewaspausedaftereachvideocliptoallow validityhasbeenreported(Garnefskietal.,2004,2005).
participantstimetocomprehendandanswerthequestions.
Part1:TheEmotionEvaluationTest comprises28shortvideo PROCEDURE
clipsinwhichanactorportraysoneofsixbasicemotions(happy, Subjectsweretestedindividuallyinadedicatedtestinglaboratory.
sad, fear, disgust, surprise, or anger). The maximum attainable Administration time was approximately 3h. Participants were
accuracyscoreis28. reimbursedfortheirtimeandtravelexpenses.
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Rowlandetal. Emotionregulationinpsychosis
RESULTS GROUPDIFFERENCESINPERFORMANCEONTHEEKMAN60-FACES
Descriptivestatisticsfordemographicandclinicaldatacollected TASK
using the PANSS are presented in Table 1. One-way analysis ToinvestigategroupdifferencesinEkmanperformance,wecon-
of variance (ANOVA) was conducted to investigate group dif- ductedamultivariateanalysisofvariance(MANOVA)withgroup
ferences in age and a Chi-squared analysis to examine gender (SZ,BD,and HC) as the independent variable and accuracy on
distribution.Therewerenodifferencesinsexdistributionamong the Ekman 60-faces task entered as dependent variables. Group
the three groups. However, there was a significant group dif- means and SD for facial emotion recognition accuracy are pre-
ference in age (see Table 1); Tukey’s HSD tests revealed that sented in Table 2. There was a significant main effect of group
both SZ (p<0.0001) and BD (p<0.01) groups were signifi- fortherecognitionaccuracyofpositive,negative,andtotalemo-
cantly older than the HC group, but the SZ and BD groups tions(seeTable2).Subsequentunivariateanalysesofcovariance
did not significantly differ in age (p=0.262). Age was thus (ANCOVAs) were used to examine pairwise group differences
employed as a covariate in focal analyses of the clinical and between individual patient groups and controls, controlling for
HC groups. Unsurprisingly, a significant difference in PANSS age.Theseanalysesrevealedthat,incomparisontotheHCgroup,
scores was found between the SZ and BD groups, where SZ SZparticipantsdemonstratedimpairmentsintherecognitionof
participants reported significantly higher levels of symptoms positive (F =4.44, p=0.037; partial η2=0.038) and neg-
2,113
than the BD participants on all three subscales; positive symp- ative emotions (F =8.45, p=0.004; partial η2=0.071), as
2,113
toms(F =27.54,p<0.0001;η2=0.240),negativesymptoms wellasoverallemotionrecognition(F =9.23,p=0.003;par-
1,88 2,113
(F =20.57, p<0.0001; η2=0.191), and general symptoms tial η2=0.077). ANOVAs examining clinical group differences
1,88
(F =7.76,p=0.007;η2=0.082). showed poorer performance in the SZ than the BD group in
1,88
Table1|DemographicinformationandPANSSscoresforeachgroup.
SZ(n=56) BD-I(n=33) HC(n=58) Statisticalvalues Effectsize Directionofsignificant
formaineffects groupdifferences
Age(years) 44.57(10.37) 40.67(11.27) 33.91(12.24) F2,146=12.81,p<0.0001 η2=0.151 SZ>HC***,BD>HC*
Gender(M/F) 32/24 18/15 29/29 χ2=0.596,p=0.742 ns
PANSSpositivesymptoms 16.32(7.09) 9.36(3.58) F1,88=27.54,p<0.0001 η2=0.240 SZ>BD***
PANSSnegativesymptoms 17.34(7.50) 10.91(4.09) F1,88=20.57,p<0.0001 η2=0.191 SZ>BD***
PANSSgeneralsymptoms 31.14(9.84) 25.88(5.93) F1,88=7.76,p=0.007 η2=0.082 SZ>BD**
PANSStotal 64.80(19.68) 46.64(10.55) F1,88=20.57,p<0.0001 η2=0.216 SZ>BD***
***p<0.001,**p<0.01,and*p<0.05.
PANSS,PositiveandNegativeSyndromeScale.
Table2|MeansandSDforallgroupsonthesocialcognitionmeasures.
SZ BD HC Statisticalvalues Effectsize Directionofsignificant
formaineffects groupdifferences
Ekmansubscale (n=56) (n=33) (n=58)
andtotalscores
Positiveemotions 17.89(2.35) 18.61(1.48) 18.84(1.58) F2,146=3.80,p=0.025 η2=0.050 SZ<HC*
Negativeemotions 26.95(6.92) 30.88(3.85) 30.38(4.44) F2,146=7.80,p=0.001 η2=0.098 SZ<BD**;SZ<HC**
Overalltotal 44.84(8.63) 49.48(3.99) 49.22(4.71) F2,146=8.55,p<0.0001 η2=0.106 SZ<BD**;SZ<HC**
TASITsubscaleand (n=47) (n=27) (n=47)
totalscores
Part1 22.11(4.17) 23.52(2.82) 24.62(2.72) F2,120=6.524,p=0.002 η2=0.101 SZ<HC***
Part2 45.68(9.35) 53.37(4.99) 53.68(5.97) F2,120=16.75,p<0.0001 η2=0.221 SZ<BD***;SZ<HC***
Part3 48.19(6.69) 52.33(6.78) 55.96(5.54) F2,120=17.93,p<0.0001 η2=0.233 SZ<BD*;SZ<HC***;BD<HC*
Overalltotal 115.98(16.97) 129.22(12.28) 134.26(12.01) F2,120=20.34,p<0.0001 η2=0.256 SZ<BD***;SZ<HC***
***p<0.001,**p<0.01,and*p<0.05.
Ekman,Ekman60-facestask;TASIT,TheAwarenessofSocialInferenceTest.
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Rowlandetal. Emotionregulationinpsychosis
negative(F =9.10,p=0.004;η2=0.094)andoverallemotion blamingothers,catastrophizing,andself-blame,butnotforaccep-
1,88
recognition (F =8.47,p=0.005;η2=0.089). There were no tance,puttingintoperspective,positiverefocusing,orrefocuson
1,88
significant differences in emotion recognition accuracy between planning(seeTable3).
theBDandHCgroups. In focal analyses of clinical and control groups on the sig-
nificant CERQ subscales, a series of ANCOVAs were under-
GROUPDIFFERENCESINTASITPERFORMANCE taken to examine pairwise group differences in the frequency
GroupmeansandSDforTASITperformancearesummarizedin of use of these strategies, controlling for age. In comparison
Table2.ToinvestigategroupdifferencesinTASITperformance, to the HC group, SZ participants were more likely to engage
we conducted a MANOVA with group as the independent vari- in catastrophizing (F2,67=10.78, p=0.002; partial η2=0.142)
able (SZ, BD, and HC), and TASIT subscale (Part 1 – Emotion and rumination (F2,67=3.99, p=0.05; partial η2=0.058),
Evaluation Test, Part 2 – Social Inference: Minimal, and Part while BD participants reported less use of positive reappraisal
3 – Social Inference: Enriched) and overall total scores entered (F2,59=9.38, p=0.003; partial η2=0.141) and greater use
as dependent variables. There was a significant main effect of of self-blame (F2,59=5.15, p=0.027; partial η2=0.083). An
group for all four scores;Part 1,Part 2,Part 3,and overall total ANOVA comparing the patient groups showed SZ partici-
score (see Table 2). Subsequent ANCOVAs examining specific pants were more likely to employ the regulatory strategy of
group differences between the clinical and control groups,con- blaming others than BD participants (F2155=5.86, p=0.019;
trolling for age, showed that in comparison to the HC group η2=0.098).
SZ participants demonstrated impairments in every component
oftheTASIT:Part1(F2,93=4.52,p=0.036;partialη2=0.047); ASSOCIATIONOFSOCIALCOGNITIVEPERFORMANCEWITHCERQ
Part2(F2,93=18.54,p<0.0001;partialη2=0.169);andPart3 Zero-ordercorrelationsbetweensocialcognitiveperformanceand
(F2,93=22.03, p<0.0001; partial η2=0.195). The only differ- CERQsubscaleswerecarriedoutusingPearson’sproduct-moment
ence between scores for the BD and HC groups was on Part correlations.Associationsbetweenemotionrecognitionaccuracy
3, with BD participants showing deficits on the threshold of ontheEkmantaskandCERQsubscalesarereportedinTable4.
significant (F2,73=3.97, p=0.05; partial η2=0.053). Further TheonlysignificantcorrelationswerefortheHCgroup,withthe
ANOVAs undertaken for pairwise comparisons of the clinical Ekmanpositiveemotionssubscalescoreshowingpositiveassoci-
groupsshowedthatSZhadmoredifficultyperformingthanBD ationswiththeCERQsubscalesacceptance(r=0.501,p=0.002)
patientsonPart2(F1,73=15.65,p<0.0001;η2=0.179),Part3 andputtingintoperspective(r=0.429,p=0.009).Therewereno
(F1,73=6.51, p=0.013; η2=0.083), and overall (F1,73=12.62, significant correlations for either the SZ or BD groups. Subse-
p=0.001;η2=0.149). quently,statisticalcomparisonofcorrelationcoefficientsforinde-
pendent samples was conducted via the Fisher z transformation
FREQUENCYOFUSEOFCOGNITIVEEMOTIONREGULATION ofr procedure(CohenandCohen,1983)toinvestigatepairwise
QUESTIONNAIRESTRATEGIES groupdifferencesintheEkmanscoresandCERQsubscalesthat
GroupmeansandSDforCERQsubscalesarereportedinTable3. were correlated for controls but not for patients. For all com-
ToinvestigategroupdifferencesinthefrequencyofuseofCERQ parisons between the SZ and HC groups there was a significant
strategies (represented by total scores on each subscale), we difference between correlations (positive emotions with: accep-
conducted a MANOVA with group (SZ, BD, and HC) as the tanceZ=−2.45,p=0.014;puttingintoperspectiveZ=−2.14,
independentvariable,andtotalscoresoneachofthenineCERQ p=0.032).ForBDandHC,thecorrelationswerealsofoundto
subscales entered as dependent variables. This revealed a signif- differsignificantlybetweengroups(positiveemotionswith:accep-
icant main effect of group for rumination, positive reappraisal, tanceZ=−2.40,p=0.016;puttingintoperspectiveZ=−2.21,
Table3|MeansandSDforallgroupsontheCERQ.
CERQsubscale SZ(n=32) BD(n=24) HC(n=36) Statisticalvalues Effectsize Directionofsignificant
formaineffects groupdifferences
Rumination 14.56(5.95) 13.54(3.31) 11.69(3.65) F2,91=3.53,p=0.034 η2=0.073 SZ>HC**;BD>HC**
Positivereappraisal 14.13(4.11) 12.58(4.09) 15.50(3.12) F2,91=4.40,p=0.015 η2=0.091 BD<HC*
Other-blame 10.59(4.53) 8.04(2.85) 8.61(3.21) F2,91=4.01,p=0.021 η2=0.083 SZ>BD**;SZ>HC**
Acceptance 13.66(3.41) 12.71(3.21) 12.86(3.28) F2,91=0.71,p=0.492 ns
Catastrophizing 11.31(4.37) 10.33(4.29) 8.25(3.24) F2,91=5.36,p=0.006 η2=0.107 SZ>HC**;BD>HC**
Puttingintoperspective 13.06(3.89) 13.71(8.67) 15.14(3.62) F2,91=1.28,p=0.282 ns
Positiverefocusing 11.66(3.69) 10.00(4.17) 12.00(3.38) F2,91=2.25,p=0.111 ns
Refocusonplanning 15.59(7.64) 13.42(3.83) 15.44(2.87) F2,91=1.43,p=0.244 ns
Self-blame 11.94(3.41) 12.75(4.95) 10.33(3.24) F2,91=3.19,p=0.046 η2=0.067 BD>SZ*>HC**
**p<0.01and*p<0.05.
CERQ,CognitiveEmotionRegulationQuestionnaire.
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Rowlandetal. Emotionregulationinpsychosis
Table4|Pearson’stwo-tailedcorrelationsbetweenEkmanscoresandCERQstrategiesforSZ,BD,andHCgroups.
CERQsubscales Ekman60-facesscores
Positiveemotions Negativeemotions Totalscore
SZ BD HC SZ BD HC SZ BD HC
Rumination −0.180 0.073 0.124 −0.096 −0.254 0.137 −0.129 −0.214 0.165
PositiveReappraisal −0.123 −0.084 −0.003 −0.135 −0.027 0.050 −0.148 −0.053 0.045
Other-blame −0.265 0.227 0.134 −0.163 −0.382 −0.215 −0.209 −0.284 −0.156
Acceptance −0.073 −0.120 0.501** −0.159 −0.118 0.077 −0.155 −0.151 0.229
Catastrophizing −0.245 0.080 0.052 −0.279 −0.113 −0.282 −0.303 −0.080 −0.243
Puttinginperspective −0.086 −0.156 0.429** −0.192 0.066 0.266 −0.188 0.011 0.380
Positiverefocusing −0.098 −0.202 −0.134 0.010 −0.190 0.014 −0.016 −0.246 −0.029
Refocusonplanning −0.273 −0.083 0.183 −0.102 −0.115 0.035 −0.158 −0.136 0.090
Self-blame 0.055 0.084 0.273 −0.153 −0.108 −0.106 −0.117 −0.074 −0.012
**p<0.01.
CERQ,CognitiveEmotionRegulationQuestionnaire.
p=0.027). There was no significant difference between SZ and diagnosticsforcollinearityofEkman,andTASITpredictorswere
BDinthecorrelationsforthesevariables. therefore considered in subsequent regression analyses by Vari-
Similarly, significant correlations between TASIT scores and ance Inflation Factor (VIF) scores, where VIF scores above 10
CERQsubscaleswerefoundfortheHCgrouponly,asreported are considered of serious concern. No VIF score was found to
in Table 5. Significant negative associations were found in beabove3.
the HC group between TASIT Part 2 scores and the fre- Insupportof thecorrelationalpattern,theseanalysesyielded
quent use of rumination (r=−0.452, p=0.008), catastrophiz- significantregressionmodelsfortheHCgrouponly,withnovari-
ing (r=−0.476, p=0.005), and blaming others (r=−0.498, ablesreachingsignificanceforentryintoanymodelforeitherthe
p=0.003). TASIT Part 3 showed negative correlations with SZ or BD groups. For the HC group,positive emotion recogni-
catastrophizing (r=−0.538, p=0.001) and blaming others tionaccuracyontheEkmantaskwasfoundtoexplain20.8%of
(r=−0.451, p=0.008) as did overall TASIT performance the variance in the frequency of use of acceptance (F =9.43,
1,32
with catastrophizing (r=−0.549,p=0.001) and blaming others p=0.004; Adjusted R2=0.208). Performance on TASIT Part 2
(r=−0.506, p=0.003). Again, there were no significant corre- wasfoundtoexplain17.9%ofthevarianceinthefrequencyofuse
lationsforeithertheSZorBDgroups.Statisticalcomparisonof ofrumination(F =7.98,p=0.008;AdjustedR2=0.179)and
1,32
correlationcoefficientsforindependentsampleswassubsequently 22.3%ofthevarianceintheuseofblamingothers(F =10.20,
1,32
conductedtoinvestigatepairwisegroupdifferencesintheseasso- p=0.003; Adjusted R2=0.223). TASIT Part 3 scores explained
ciations.ForTASITPart2,thecorrelationswithbothrumination 26.6% of the variance in frequency of use of catastrophizing
(Z=3.06,p=0.002)andcatastrophizing(Z=4.48,p<0.0001) (F =7.69,p=0.001;AdjustedR2=0.266).
1,32
differed significantly between the BD and HC groups, as did
thecorrelationsof TASITPart3withcatastrophizing(Z=2.92, DISCUSSION
p=0.004).TheassociationsbetweenTASITscoresandblaming Thisstudysetouttoexaminetherelationshipbetweensocialcog-
others showed no significant group differences in coefficients. nitive abilities and the frequency of use of cognitive strategies
NoneofthecomparisonsofcorrelationsbetweenSZandHCor forregulatingnegativeemotioninpatientswithSZandBD.We
SZandBDgroupsweresignificant. firstlyexaminedperformanceonsocialcognitivetasksofemotion
perceptionandhigherordersocialcognition(i.e.,ToM)between
SOCIALCOGNITIVEPREDICTORSOFFREQUENCYOFUSEOFCERQ the clinical and control groups. As predicted, SZ participants’
STRATEGIES demonstrated greater impairments in social cognition (encom-
To further examine the pattern of correlations between social passingbothbasicemotionprocessingandToM)relativetoBD,
cognitive performance and the CERQ, a series of nine step- whoonlyshowedimpairmentonhigherordersocialcognitionon
wise multiple regression analyses were conducted to test which theTASIT(butnotbasicemotionperception)comparedtoHC.
of the social cognition scores best predicted frequency of use In addition, there were distinct patterns of CERQ performance
of CERQ strategies in the three experimental groups, using the in both patient groups,with both SZ and BD groups reporting
CERQsubscalesasdependentvariables,controllingforage.Per- more frequent use of maladaptive emotion regulation strategies
formancescoresoneachoftheEkmanandTASITsubscaleswere (namely,rumination,catastrophizing,andself-blame),aswellas
enteredasindependentvariables;significancelevelforentrywas lessuseoftheadaptivestrategyofputtingintoperspective,relative
set at 0.01 to reduce type-I error. As the correlations also show toHC.Examinationoftherelationshipbetweensocialcognition
the existence of collinearity among social cognition subscales, and cognitive emotion regulation revealed associations for HC
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Rowlandetal. Emotionregulationinpsychosis
Table5|Pearson’stwo-tailedcorrelationsbetweenTASITscoresandCERQstrategiesforSZ,BD,andHCgroups.
CERQsubscales TASITsubscales
Part1 Part2 Part3 Total
SZ BD HC SZ BD HC SZ BD HC SZ BD HC
Rumination −0.044 0.231 −0.184 −0.192 0.376 −0.452** −0.376 0.305 −0.293 −0.272 0.369 −0.396
Positivereappraisal −0.063 −0.085 0.015 −0.344 0.007 0.087 −0.258 −0.074 −0.015 −0.310 −0.055 0.038
Other-blame −0.261 −0.065 −0.247 −0.091 −0.086 −0.498** −0.204 −0.164 −0.451** −0.177 −0.138 −0.506**
Acceptance −0.252 0.203 0.042 −0.233 −0.098 −0.007 −0.276 −0.05 −0.040 −0.284 −0.028 −0.013
Catastrophizing −0.222 0.135 −0.299 −0.092 0.065 −0.476** −0.268 0.238 −0.538*** −0.198 0.185 −0.549***
Puttinginperspective −0.052 −0.013 0.018 −0.263 0.100 0.130 −0.151 0.018 0.154 −0.217 0.048 0.139
Positiverefocusing 0.131 −0.185 0.090 0.054 −0.167 −0.002 0.087 −0.290 −0.124 0.087 −0.265 −0.038
Refocusonplanning −0.286 −0.102 −0.014 −0.044 0.079 0.112 0.064 −0.120 −0.057 −0.040 −0.054 0.024
Self-blame −0.083 0.336 −0.177 −0.069 0.191 −0.285 −0.091 0.294 −0.224 −0.089 0.309 −0.282
***p<0.001and**p<0.01.
TASIT,TheAwarenessofSocialInferenceTest;CERQ,CognitiveEmotionRegulationQuestionnaire.
participantsonly,withhigherlevelsofemotionrecognitionbeing group. It thus appears that the basic emotion perception and
associatedwithgreateruseofthestrategyofputtingintoperspec- ToM abilities of SZ patients are compromised not only in rela-
tive,andbetterTASITperformanceassociatedwithlessfrequent tion to non-patient controls but also in comparison to patients
useofrumination,catastrophizing,andblamingothers.Contrary withBD.
to predictions, no associations between social cognitive perfor- With regard to the frequency of use of particular cognitive
manceandcognitiveregulatorystrategieswererevealedforeither strategiesemployedtoregulatenegativeemotion,thetendencyfor
theSZorBDgroups.Furtherinvestigationof thedifferencesin SZandBDpatientstoemploymaladaptiveapproachestoregulate
correlation coefficients for those performance scores and CERQ affect is consistent with the style demonstrated in other studies
subscales that were correlated for controls but not for patients (Greenetal.,2011;Rowlandetal.,inrevision),andinotherdisor-
showed the relationships between positive emotion recognition derssuchasdepression(Garnefskietal.,2002).Onedistinctionis
andtheuseofadaptivereframingstrategiesdifferedbetweenthe thatSZparticipantsemployedother-blamemorefrequentlythan
clinical and HC groups, while the relationships between ToM bothBDandHCgroups,whileBDparticipantsuniquelydemon-
abilities and the use of maladaptive strategies (rumination and strated greater use of self-blame compared to both SZ and HC
catastrophizing)differedbetweentheBDandHCgroups.Addi- groups, less positive refocusing compared to the SZ group, and
tionally, there was no difference between the clinical groups in lesspositivereappraisalthancontrols.Thesefindingsarealsocon-
the correlations for these variables. Finally, with regard to the sistentwithpreviousevidence(Livingstoneetal.,2009;Rowland
predictiveutilityofsocialcognitiveperformance:withinthecon- etal.,inrevision).
trol group, recognition accuracy of positive emotions predicted Incontrasttoourpredictions,examinationoftherelationship
greateruseof acceptance,withtheadditionof poorTASITper- between social cognition and emotion regulation revealed asso-
formancepredictingincreaseduseofrumination,blamingothers, ciations for HC participants only, with no associations present
andcatastrophizing. ineithertheSZorBDgroups.However,thespecificassociations
The present findings for social cognitive impairments in SZ found for the HC group were as expected,with the recognition
and BD converge with previous evidence for emotion percep- of positive emotions found to be positively associated with the
tion deficits in SZ (Addington and Addington, 1998; Edwards CERQstrategyofacceptance,and(bothpositiveandoverall)emo-
et al., 2002; Sparks et al., 2010), as well as a number of studies tionrecognitionshowingpositiveassociationswiththetendency
showing ToM deficits in SZ and BD (Addington and Adding- to put things into perspective. Furthermore, within the control
ton,1998;Kerr et al.,2003;Bora et al.,2005;Brune,2005;Har- group, recognition accuracy of positive emotions actually pre-
rington et al., 2005; Olley et al., 2005; Montag et al., 2010). dictedgreateruseofthepositivereframingstrategyofacceptance.
Our results for SZ are especially consistent with recent stud- Thissuggeststhatforpeoplewithnohistoryofmentalillness,the
ies showing impaired sarcasm perception (Kern et al., 2009; ability to accurately recognize facial affect expression,and posi-
Sparks et al., 2010) and social context processing (Green et al., tiveaffectinparticular,isrelatedtomorefrequentuseofadaptive
2007b, 2008). However, in contrast to previous studies where cognitivereframingstrategies.Inaddition,forHCtherewasalso
both SZ and BD patients have shown impaired facial emotion anegativeassociationbetweenTASITperformanceandfrequent
perception in comparison to community controls (Addington useofrumination,catastrophizing,andblamingothers.Ofthese,
and Addington, 1998), there were no such deficits in the BD performance on Part 2 of the TASIT (Social Inference – Mini-
group.Additionally,the SZ group was found to be impaired on mal)wasmostpredictiveof theuseof ruminationandblaming
both the Ekman and TASIT tasks when compared to the BD others, while Part 3 (Social Inference – Enriched) performance
FrontiersinPsychology|EmotionScience January2013|Volume3|Article607|8
Rowlandetal. Emotionregulationinpsychosis
best predicted use of catastrophizing, indicating that accurate strict hypotheses (rather than exploratory analyses as presented
socialcognitiveskillsareassociatedwithlessfrequentuseofthese here),toreplicatecurrentfindings,willbenecessarytodetermine
maladaptive emotion regulation strategies. While these findings thereliabilityofthecurrentresults.
confirmexpectedrelationshipsbetweensocialcognitiveskillsand Insummary,thepresentfindingsareconsistentwithprevious
thecapacitytoimplementadaptivestrategiesforemotionregula- evidence for social cognitive impairments and maladaptive pat-
tioninnon-clinical(healthy)individuals,theyalsohighlightthe ternsofemotionregulationinSZandBD.Weaimedtoexamine
lackof“normal”associationsbetweensocialcognitionandemo- associations between social cognitive performance and emotion
tionregulatorystylesinSZandBD.Inthecontextofevidencethat regulatorystylesinSZandBD,howevertheexpectedassociations
a number of these associations differ significantly between the wererevealedfortheHCgrouponly.Itispossiblethatcompetency
clinicalandcontrolgroups,itappearsthatknownlinksbetween intheexecutionofspecificemotionregulationstrategiesmayrest
socialcognitionandthecapacitytoself-regulatenegativeemotion on other neuropsychological skills (e.g., executive functioning)
arenotintactinpsychoticindividuals. not tested here, rather than being mediated via social cognitive
The present findings may be limited by a number of factors. skillsinBDandSZ.Thelackof associationbetweensocialcog-
First,itispossiblethatthelimitedrangeof scoresforSZorBD nitionandcognitiveemotionregulationinthepatientgroupsis,
onsomesocialcognitivemeasurescouldhaveimpededthecapac- however,consistentwithalackofintegrityoffronto-limbicbrain
itytorevealsignificantassociationsbetweenthesemeasuresand networks(Morrisetal.,2012).Thecurrentfindingssuggestthat
cognitiveregulatorystrategies.Thisisplausibleinthecontextof dysfunctioninthesebrainnetworksmayunderpinbothsocialcog-
thesignificantassociationsfoundforHC.Thismayalsoberelated nitivedeficitsandregulatorycapacities,albeitviadifferentroutes.
to the relatively small sample sizes for each participant group, Furtherinvestigationof theassociationbetweensocialcognitive
whichmayhavelimitedthepowertodetectwithin-groupassoci- skills and emotion regulation capacities in psychotic disorders,
ationsbetweensocialcognitionandCERQstrategies,andwhich ideallyintegratingneurofunctionalandneuroanatomicaldata,is
precludedanalysesoftheeffectsofillnessphases(e.g.,depressed, warranted.
euthymic,andmanic)oftheBDgroupinparticular.Secondly,it
should be noted that TASIT performance relies heavily on the ACKNOWLEDGMENTS
interpretation of sarcasm in scenarios involving fluent English This research was supported by the Australian National Health
speakers,and we do not know whether these findings involving andMedicalResearchCouncil(NHMRC)ProjectGrantheldby
TASIT would translate across cultures. Thirdly, the reliance on Green(#630471),anduseddatafromtheAustralianSchizophrenia
self-reporttomeasureself-regulationofaffectcanbeproblematic ResearchBank,fundedbytheNHMRCEnablingGrant(#386500
inthatindividualsmaynotalwaysbeconsciouslyawareorsureof held by V. Carr, U. Schall, R. Scott, A. Jablensky, B. Mowry, P.
theirownuseofcognitiveemotionregulationstrategiesinstress- Michie, S. Catts, F. Henskens, and C. Pantelis; Chief Investiga-
fulsituations;thesemaybecontext-dependentorunconsciously tors),andthePrattFoundation,RamsayHealthCare,theViertel
triggered and can be impacted by memory biases. Additionally, CharitableFoundation,aswelltheSchizophreniaResearchInsti-
theCERQonlyassessesregulationofnegativeemotion,anddoes tute, using an infrastructure grant from the NSW Ministry of
not take into account strategies utilized in response to positive Health.MelissaJ.GreenwassupportedbyanAustralianResearch
events. A potentially serious limitation of this study is that we CouncilFutureFellowship(FT0991511).WeacknowledgeCarmel
havenotexaminedtheeffectsofmedicationonourresults;given Loughland,KathrynMcCabe,andJasonBridgeformanagement
thatmanySZandBDpatientswerereceivingpharmacotherapy, and quality control of data obtained from theAustralian Schiz-
future studies would benefit from further investigation of these ophrenia Research Bank.We would like to thankVaughan Carr
factors. Fourth, since the participants in this study were out- forprovidingsomehelpfulcommentsonthedraftofthismanu-
patients living in the community, it may not be appropriate to script.Wewouldalsoliketothankthevolunteerswhoparticipated
generalizetheimplicationsofthepresentfindingstoindividuals in this study. Funding source: This research was supported by
whoareexperiencingacutesymptomsorthoseresidingininpa- the National Health and Medical Research Council of Australia
tientsettings.Finally,wenotethatthelargenumberof analyses (ProjectGrant630471andProgramGrant510135)andtheAus-
performedinthisstudyprecludedtheutilityofaformalcorrec- tralianResearchCouncil(FutureFellowshipFT0991511,heldby
tion for multiple testing; despite setting a reduced significance MelissaJ.Green).Thefundingbodieshadnoroleinthedesign
level(p<0.01),itispossiblethatsomespuriousassociationswere of the study, collection and analysis of data, or the decision to
revealedinthisstudy.Furtherresearchwithlargersamples,testing publish.
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