Corrigendum: Thinking preferences and conspiracy belief: intuitive thinking and the jumping to conclusions-bias as a basis for the belief in conspiracy theories.

[This corrects the article DOI: 10.3389/fpsyt.2020.568942.].

[Current evidence for various inpatient psychotherapy programs in the treatment of psychoses-A narrative review article]. / Aktuelle Evidenz verschiedener stationärer Psychotherapieprogramme in der Behandlung von Psychosen ­ ein narrativer Übersichtsartikel.

BACKGROUND: The analysis of the efficacy of evidence-based psychotherapy for patients with psychotic disorders has mostly been carried out in the outpatient field. In the inpatient field the efficacy is sometimes difficult to assess due to different healthcare systems. OBJECTIVE: The aim of this narrative review is to summarize international guidelines and meta-analyses on the efficacy of inpatient psychotherapeutic treatment strategies for patients with psychotic disorders. Based on this, recommendations for disorder-specific ward concepts for acute and postacute fields are formulated. METHODS: The German S3 guidelines, international guidelines, current meta-analyses and primary studies on psychological interventions in the treatment of psychotic disorders were included. Based on the results, recommendations for the inpatient psychotherapeutic treatment in various phases of treatment were formulated (acute phase and postacute phase). RESULTS: In the acute phase a combination of cognitive behavioral therapy (CBTp) in the individual setting and family interventions in the group setting as well as metacognitive training (MCT acute) is effective and recommended. In the postacute phase, in addition to individual and group CBTp and family interventions, psychoeducation, social skills training and cognitive remediation have been shown to be effective and are recommended. DISCUSSION: The suggested recommendations for concrete interventions in various treatment phases and the evidence base are critically discussed and recommendations for the structure of wards are presented.

Feasibility and efficacy of an acceptance and mindfulness-based group intervention for young people with early psychosis (Feel-Good group).

Background: Over the last decade, researchers have sought for alternative interventions that have better treatment effects than Cognitive Behavioral Therapy (CBT) when treating psychotic symptoms. Mindfulness-based interventions have been a proposed alternative to CBT, yet research regarding its feasibility, acceptance and effectiveness is lacking when treating individuals with early psychosis in inpatient settings. Objective: Before conducting a large-scale randomized-controlled trial (RCT), this pilot study evaluated the feasibility and the potential efficacy of a mindfulness-based inpatient group intervention that targets emotion regulation in patients with early psychosis, and thus indirectly improving psychotic symptoms. Methods: A pre-post study was performed. Thirty-six patients with early psychosis treated at the specialized inpatient treatment "Frühinterventions- und Therapiezentrum; FRITZ" (early intervention and therapy center) received eight group therapy sessions. Assessments were performed at baseline, after 8 weeks post treatment and at follow-up after 16 weeks. Results: Rates of patients who participated in the study suggests that a mindfulness-based group therapy is highly accepted and feasible for patients with early psychosis being treated in an inpatient ward. Friedman analyses revealed significant changes in the primary outcomes of emotional goal attainment (Goal 1: W = 0.79; Goal 2: W = 0.71) and psychotic symptoms (PANSS-T: W = 0.74). Significant, albeit small, effect sizes were found in patients' self-perception of emotion regulation skills (ERSQ: W = 0.23). Discussion: We found favorable findings regarding the feasibility and acceptance of the Feel-Good mindfulness-based intervention. Results of the study provide a basis for an estimation of an adequate sample size for a fully powered RCT that needs to be conducted to test whether Feel-Good is effective in the inpatient treatment of psychotic symptoms for individuals with early psychosis. Clinical trial registration: [https://clinicaltrials.gov/ct2/show/NCT04592042], identifier [NCT04592042].

Group therapy for schizophrenia: Why Burlingame et al. (2020) should redo their meta-analysis.

Comments on the meta-analysis by G. M. Burlingame et al. (see record 2020-37337-001) on group therapy in schizophrenia. The commenting authors explain why they think that the meta-analysis is seriously flawed and should be recalculated and updated. First, however, they briefly reflect on the role of meta-analyses in contemporary research to emphasize that this discussion is not merely an academic debate but may have significant implications for the psychotherapeutic landscape as a whole. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Teaching Cognitive Behavior Therapy to Postgraduate Health Care Professionals in Times of COVID 19 - An Asynchronous Blended Learning Environment Proved to Be Non-inferior to In-Person Training.

Training of postgraduate health professionals on their way to becoming licensed therapists for Cognitive Behavior Therapy (CBT) came to a halt in Germany in March 2020 when social distancing regulations came into effect. Since the German healthcare system almost exclusively relies on this profession when it comes to the implementation of CBT and 80% of those therapists active in 2010 will have retired at the end of 2030, it is critical to assess whether online CBT training is as satisfactory as classroom on-site CBT training. An asynchronous, blended, inverted-classroom online learning environment for CBT training (CBT for psychosis) was developed as an emergency solution. It consisted of pre-recorded CBT video lectures, exercises to train interventions in online role-plays, and regular web conferences. Training was provided at five different training institutes in Germany (duration 8-16 h). Postgraduate health care professionals (psychiatrists and psychologists) (n = 43) who received the online CBT training filled out standard self-report evaluations that assessed satisfaction and didactic quality. These evaluations were compared to those evaluations of students (n = 142) who had received in-person CBT training with identical content offered by the same CBT trainer at the same training institutes before the COVID-19 crisis. Both groups were comparable with respect to interest in the subject and prior knowledge. We tested non-inferiority hypotheses using Wilcoxon-Mann-Whitney ROC-curve analyses with an equivalence margin corresponding to a small-to-medium effect size (d = 0.35). The online training evaluations were non-inferior concerning information content, conception of content, didactic presentation, assessment of the trainer as a suitable role-model, working atmosphere, own commitment, and practical relevance. In contrast, we could not exclude a small effect in favor of in-person training in professional benefit and room for active participation. Our results suggest that delivering substantial CBT knowledge online to postgraduate health-professionals is sufficient, and at most incurs minimal loss to the learning experience. These encouraging findings indicate that integrating online elements in CBT teaching is an acceptable option even beyond social distancing requirements.

The Relationship Between Different Aspects of Theory of Mind and Symptom Clusters in Psychotic Disorders: Deconstructing Theory of Mind Into Cognitive, Affective, and Hyper Theory of Mind.

Background: Several meta-analyses highlight pronounced problems in general Theory of Mind (ToM), the ability to infer other persons' mental states, in patients with psychosis in comparison to non-clinical controls. In addition, first studies suggest associations between Hyper-ToM, an exaggerated inference of mental states to others, and delusions. Research on different ToM subtypes (Cognitive ToM, Affective ToM, and Hyper-ToM) and symptom clusters of psychosis (positive, negative, and disorganized symptoms) have gathered conflicting findings. Thus, the present study examined group differences between patients with psychosis and non-clinical controls concerning Cognitive ToM/Affective ToM and Hyper-ToM. Further, the association between ToM subtypes and symptom clusters (positive, negative, and disorganized symptoms) were examined. Methods: Patients with psychotic disorders (n = 64, 1/3 with present delusions indicated by a minimum score of four in the PANSS P1 item) and non-clinical controls (n = 21) were examined with assessments of Cognitive ToM and Affective ToM abilities and Hyper-ToM errors using the Frith-Happé animations. Psychopathology was assessed using the Positive and Negative Syndrome Scale. Results: Patients with psychosis presented more pronounced problems in Cognitive and Affective ToM in comparison to non-clinical controls, whereas there were no group differences with regard to Hyper-ToM errors. Furthermore, deficits in Cognitive ToM were associated with general delusions, whereas problems in Affective ToM were associated with negative and disorganized symptoms. In addition, there was no association between Hyper-ToM errors and any symptoms when controlling for years of education. Conclusions: Our findings suggest that deficits in ToM subtypes might not be directly related to delusions and positive symptoms and are in line with more recently developed cognitive models of delusions. In addition, our results support the well-established finding of associations between ToM alterations and negative or disorganized symptoms. Our results shed light on the role of different dimensions of ToM in specific symptoms of psychosis.

Corrigendum: Thinking Preferences and Conspiracy Belief: Intuitive Thinking and the Jumping to Conclusions-Bias as a Basis for the Belief in Conspiracy Theories.

[This corrects the article DOI: 10.3389/fpsyt.2020.568942.].

An experimental study on the effectiveness of emotion regulation in patients with acute delusions.

BACKGROUND: Patients with psychotic disorders report to apply more maladaptive and less adaptive emotion-regulation (ER) strategies compared to healthy controls. However, few studies have used experimental designs to investigate the success in ER and the results of those at hand are equivocal. AIM: This study investigated whether patients with delusions show problems in downregulating negative affect via cognitive ER-strategies. METHOD: Patients with schizophrenia spectrum disorders and acute delusions (n = 78) and healthy controls (n = 41) took part in an ER-experiment, in which they were instructed to downregulate anxiety and sadness via three ER-strategies (reappraisal, distraction, acceptance) or not to regulate their emotions (control-condition). ER-success was measured as the change in subjective emotion-intensity and physiological indicators (skin conductance and heart rate) from before to after regulation and was analyzed with mixed-repeated-measures ANOVAs. RESULTS: We found a significant effect of the ER-strategy in the sense that the subjective emotion-intensity was significantly lower after applying the reappraisal- and distraction-strategies than after the just view-condition (p's < .001). This effect was not found for the acceptance strategy (p = .060). There was no ER-strategy ∗ time ∗ group interaction-effect F(4.918, 575.416) = 0.778, p = .564, ƞ2partial = 0.007. In all conditions, skin conductance decreased from pre- to post regulation (p < .001). CONCLUSION: Our results indicate that patients with acute delusions can successfully apply cognitive ER-strategies. Before pursuing the relevant clinical implications of this finding, further research is needed to explore the role that the type of instruction has on ER-success and the extent to which the findings can be generalized to real life settings.

Sleep and circadian rhythm disruption predict persecutory symptom severity in day-to-day life: A combined actigraphy and experience sampling study.

Sleep-related problems are prevalent in patients with psychotic disorders, yet their contribution to fluctuations in delusional experiences is less clear. This study combined actigraphy and experience-sampling methodology (ESM) to capture the relation between sleep and next-day persecutory symptoms in patients with psychosis and prevailing delusions. Individuals with current persecutory delusions (PD; n = 67) and healthy controls (HC; n = 39) were assessed over 6 consecutive days. Objective sleep and circadian rhythm measures were assessed using actigraphy. Every morning upon awakening, subjective sleep quality was measured using ESM. Momentary assessments of affect and persecutory symptoms were gathered at 10 random time points each day using ESM. Robust linear mixed modeling was performed to assess the predictive value of sleep measures on affect and daytime persecutory symptoms. PD showed significantly lower scores for subjective quality of sleep but significantly higher actigraphic-measured sleep duration and efficiency compared with HC. Circadian rhythm disruption was associated with more pronounced severity of persecutory symptoms in HC. Low actigraphy-derived sleep efficiency was predictive of next-day persecutory symptoms in the combined sample. Negative affect was partly associated with sleep measures and persecutory symptoms. Our results imply an immediate relationship between disrupted sleep and persecutory symptoms in day-to-day life. They also emphasize the relevance of circadian rhythm disruption for persecutory symptoms. Therapeutic interventions that aim to reduce persecutory symptoms could benefit from including modules aimed at improving sleep efficacy, stabilizing sleep-wake patterns, and reducing negative affect. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Problems in measuring the JTC-bias in patients with psychotic disorders with the fish task: a secondary analysis of a baseline assessment of a randomized controlled trial.

BACKGROUND: The jumping to conclusions bias (JTC) is considered to be an important causal factor in theoretical models for the formation and maintenance of delusions. However, recent meta-analytic findings show a rather equivocal pattern of results regarding associations between JTC and delusions. Thus, the present study aims to investigate in a large sample whether the JTC-bias is more pronounced in patients with psychotic disorders in comparison to controls and whether the JTC bias is associated with a more severe delusional conviction, persecutory delusions, and positive symptoms in general. METHODS: Patients with psychotic disorders (n = 300) enrolled in a therapy trial and healthy controls (n = 51) conducted a variant of the beads task (fish task) as a measure for the JTC-bias at the start of the trial. Further, clinical interviews were used to assess patients' delusional severity and delusional conviction. RESULTS: There were no statistically significant differences between patients with psychotic disorders (with 53% displaying the JTC-bias) and controls (41%). Furthermore, there were no statistically significant correlations between JTC measures and persecutory delusions, delusional conviction, and positive symptoms. CONCLUSIONS: We found no differences in JTC between patients with psychotic disorders and healthy controls, which is in part in line with meta-analytic findings using a wide range of JTC task variants. Interestingly, patients with psychotic disorders displayed JTC rates commonly found in the literature, while healthy control subjects showed an unexpectedly high level of JTC. The task variant we used in the present study (fish task) is discussed as a potential reason for our results, as it may induce a more deliberative reasoning style in controls as compared to the traditional beads task. Furthermore, possible implications for the measurement of the JTC-bias, in general, are discussed. TRIAL REGISTRATION: ISRCTN29242879 ( isrctn.com ), date of registration: April 12th 2006, retrospectively registered.

Thinking Preferences and Conspiracy Belief: Intuitive Thinking and the Jumping to Conclusions-Bias as a Basis for the Belief in Conspiracy Theories.

BACKGROUND: The belief in conspiracy theories and paranoid ideation are often treated as almost synonymous. However, there is to date no research concerning shared underlying cognitive underpinnings of belief in conspiracy theories and paranoid ideation. One potential underlying factor could be the well-known jumping to conclusion (JTC) bias, the tendency of persons with delusions to perform hasty decisions that are sometimes based on little evidence. Furthermore, a preference for a more intuitive general thinking style, as opposed to an analytical thinking style, could be an additional underlying cognitive factor of both conspiracy theories and paranoia. Thus, the aim of the present study is to investigate in a large sample of non-clinical individuals whether the JTC-bias is more pronounced in individuals who display a stronger belief in conspiracy theories and whether both are related to a more intuitive thinking preference. METHODS: We assessed the data of 519 non-clinical individuals regarding their respective approval of 20 specific conspiracy theories in an online study. Further, we assessed the JTC-bias by using a computerized variant of the beads task (fish task). Thinking preferences were measured with the Rational-Experiential Interview. RESULTS: Subjects who displayed the JTC-bias presented a more pronounced belief in conspiracy theories. In addition, gathering little information in the fish task before performing a decision (less draws to decision) was related to a stronger endorsement of conspiracy theories and a more intuitive thinking style (and a less analytic thinking style). Finally, a preference for intuitive thinking predicted a stronger belief in conspiracy theories in a multiple regression analysis. CONCLUSIONS: Our results demonstrate the implication of a preference for an intuitive thinking style accompanied by a propensity to faster decision-making (JTC-bias) as possible cognitive underpinnings of beliefs in conspiracy theories. Furthermore, our study is the first to confirm the notion of the JTC-bias as a reflection of the use of an intuitive thinking style.

Can theory of mind be improved? Positive expectations cause better theory of mind performance in a community sample.

BACKGROUND AND OBJECTIVES: Theory of Mind (ToM) deficits are present in several mental disorders and closely related to problems in social functioning and lower quality of life. While several trainings are aimed at improving ToM performance, it is unknown whether positive expectations on a persons' ToM performance might cause better ToM achievement. METHODS: Participants (n = 131) first completed a mock ToM test and were then randomly assigned to either receive standardized positive, negative or no feedback on their ToM performance. Secondly, their expectations on their own ToM performance were assessed. Thirdly, ToM was assessed using the Movie Task for the Assessment of Social Cognition (MASC). RESULTS: Participants who received positive feedback resulted in positive expectations on their ToM performance and showed enhanced ToM performance, whereas negative feedback did not lead to negative expectations and negative expectations did not affect a change in ToM performance. LIMITATIONS: In the present exploratory study, the effect of positive expectations on ToM performance was assessed in a community sample. Thus, the study should be replicated in a clinical sample for more in-depth results. CONCLUSIONS: ToM performance could be enhanced by inducing positive expectations on one's ToM performance, whereas negative feedback had no effect. The present study suggest that interventions that focus on strengthening positive expectations on one's ToM performance could enhance the efficacy of present ToM training methods.

Effectiveness of emotion regulation in daily life in individuals with psychosis and nonclinical controls-An experience-sampling study.

Individuals with psychosis report employing more maladaptive and less adaptive emotion regulation (ER) strategies compared to nonclinical controls (NCs). However, it is unknown whether this is predictive of affect experienced in daily life and whether ER strategies are used less frequently and effectively by individuals with psychosis in daily life. Individuals with psychosis and current delusions (PDs; n = 71) and NCs (n = 42) completed questionnaires of habitual ER and experience sampling over 6 consecutive days, in which they reported 10 times a day on the presence of negative and positive affect and deployment of ER strategies (reappraisal, acceptance, awareness, suppression, rumination, distraction, and social sharing). Effectiveness of strategy use was operationalized by examining successive differences in positive and negative affect. Multilevel regression analyses were conducted. Questionnaires of habitual ER were largely predictive of affect in daily life. There was indication of a more frequent use of putatively maladaptive strategies but either no differences in individual adaptive strategies or even a more frequent use (reappraisal) in PDs compared to NCs. Several ER strategies (e.g., reappraisal, rumination) proved effective in reducing negative affect by the next prompt, independent of group, but suppression was effective in only PDs and acceptance had unfavorable effects in both groups. Thus, PDs demonstrated an increased use of ER strategies in daily life, of which the majority helped them to reduce negative affect. This indicates that their increased levels of negative affect are not explicable by difficulties in deploying explicit ER strategies. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Theory of mind, emotion recognition, delusions and the quality of the therapeutic relationship in patients with psychosis - a secondary analysis of a randomized-controlled therapy trial.

BACKGROUND: Cognitive models of psychosis postulate an important role of Theory of mind (ToM) in the formation and maintenance of delusions, but research on this plausible conjecture has gathered conflicting findings. In addition, it is still an open question whether problems in emotion recognition (ER) are associated with delusions. We examined the association of problems in ToM and ER with different aspects of delusions in a large sample of patients with psychosis enrolled in a therapy trial. This also enabled us to explore the possible impact of ToM and ER on one part of patients' social life: the quality of their therapeutic relationship. METHODS: Patients with psychotic disorders and delusions and/or hallucinations (n = 185) and healthy controls (n = 48) completed a ToM picture sequencing task and an ER task. Subsequently, patients were enrolled in a randomized-controlled Cognitive Behavior Therapy (CBT) trial (ISRCTN29242879). Patients and therapists rated the quality of the therapeutic relationship during the first five sessions of therapy. RESULTS: In comparison to controls, patients were impaired in both ToM and ER. Patients with deficits in ER experienced more severe delusional distress, whereas ToM problems were not related to delusions. In addition, deficits in ER predicted a less favorable therapeutic relationship and interactional problems viewed by the therapist. Impaired ER also moderated (increased) the negative influence of delusions on the therapeutic relationship and interactional difficulties viewed by the therapist. CONCLUSIONS: Cognitive models on the formation and maintenance of delusions should consider ER as a potential candidate that might be related to the formation and maintenance of delusional distress, whereas problems in ToM might not be directly related to delusions and secondary dimensions of delusions. In addition, problems in ER in patients with psychosis might have an impact on the quality of the therapeutic relationship and patients with problems in ER are more likely to be viewed as problematic by their therapists. Nevertheless, training ER might be a way to improve the quality of the therapeutic relationship and potentially the effectiveness of CBT or other interventions for patients with psychosis.

Awareness and rumination moderate the affective pathway to paranoia in daily life.

Numerous cross-sectional studies found psychosis to be associated with less awareness of emotions, a decreased use of adaptive (e.g. reappraisal) and an increased use of maladaptive emotion regulation (ER) strategies (e.g. suppression). In this study, we tested whether state levels of emotion awareness and momentary use of specific ER strategies moderate the link between negative affect at one timepoint (t-1) and paranoia at the next timepoint (t) in a six-day experience sampling study. Individuals with psychotic disorders (n = 71) reported on the presence of paranoia, negative affect, emotion awareness and the use of six ER strategies (reappraisal, acceptance, social sharing, distraction, suppression and rumination) ten times per day. Multilevel regression analysis revealed that higher awareness at t-1 reduced the association of negative affect at t-1 and paranoia at t, whereas rumination had an opposite, amplifying moderation effect. Our results provide novel insight into the conditions under which negative affect translates into delusional beliefs. The finding that emotion awareness and rumination have a relevant role corresponds with current psychological conceptualisations of psychosis and with the attempt to treat delusions by focusing on reducing ruminative thoughts. To investigate the causal effect, treatment trials with a focus on enhancing these components of emotion regulation are needed.

Metacognitive and cognitive-behavioral interventions for psychosis: new developments
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This review describes four cognitive approaches for the treatment of schizophrenia: cognitive-behavioral therapy for psychosis (CBTp), metacognitive therapy, metacognitive training, and metacognitive reflection insight therapy (MERIT). A central reference point of our review is a seminal paper by James Flavell, who introduced the term metacognition ("cognition about cognition"). In a way, every psychotherapeutic approach adopts a metacognitive perspective when therapists reflect with clients about their thoughts. Yet, the four approaches map onto different components of metacognition. CBTp conveys some "metacognitive knowledge" (eg, thoughts are not facts) but is mainly concerned with individual beliefs. Metacognitive therapy focuses on unhelpful metacognitive beliefs about thinking styles (eg, thought suppression). Metacognitive training brings distorted cognitive biases to the awareness of patients; a central goal is the reduction of overconfidence. MERIT focuses on larger senses of identity and highlights metacognitive knowledge about oneself and other persons. For CBTp and metacognitive training, meta-analytic evidence supports their efficacy; single studies speak for the effectiveness of MERIT and metacognitive therapy.
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Esta revisión describe cuatro enfoques cognitivos para el tratamiento de la esquizofrenia: terapia cognitivo-conductual para la psicosis (TCCp), terapia metacognitiva (TMC), entrenamiento metacognitivo (EMC) y terapia metacognitiva de reflexión (TMCR). Un punto de referencia central es un artículo seminal de James Flavell, quien introdujo el término metacognición ("cognición acerca de la cognición"). En cierto modo, cada enfoque terapéutico adopta una perspectiva metacognitiva cuando los terapeutas reflexionan con los clientes acerca de sus pensamientos. Sin embargo, los cuatro enfoques se asignan a diferentes componentes de la metacognición. La TCCp transmite algún "conocimiento metacognitivo" (p. ej. Los pensamientos no son realidades), pero se ocupa principalmente de las creencias individuales. La TMC se centra en creencias metacognitivas inútiles acerca de los estilos de pensamiento (p. ej. Supresión del pensamiento). El EMC trae sesgos cognitivos distorsionados a la conciencia de los pacientes, siendo un objetivo central la reducción del exceso de confianza. La TMCR se enfoca en sentidos de identidad más amplios y destaca el conocimiento metacognitivo sobre uno mismo y otras personas. La evidencia metaanalítica respalda la eficacia de la TCCp y el EMC, y los estudios individuales la efectividad de la TMCR y la TMC.

Cet article décrit quatre approches cognitives pour le traitement de la schizophrénie : les TCCp (Thérapie cognitivo-comportementale) pour la psychose, la TMC (thérapie métacognitive), l'EMC (entraînement métacognitif) et la MERIT (Metacognitive Reflection Insight Therapy). James Flavell est l'auteur de référence d'un article fondateur qui a introduit le terme de métacognition (« la connaissance de la connaissance ¼). D'une certaine façon, chaque approche thérapeutique adopte une perspective métacognitive lorsque le thérapeute réfléchit avec son patient sur ses pensées. Cependant les quatre approches représentent les différentes composantes de la métacognition. Les TCCp véhiculent une certaine « connaissance métacognitive ¼ (par exemple les pensées ne sont pas des faits) mais sont principalement concernées par les croyances individuelles. La TMC s'intéresse aux croyances métacognitives inutiles sur les modes de pensée (par exemple, suppression de la pensée). L'EMC aide les patients à prendre conscience des distorsions cognitives ; l'objectif central est la diminution de la sur-confiance. La MERIT se concentre sur des facultés plus larges d'identité et met en valeur la connaissance métacognitive sur soi-même et sur les autres. Des méta-analyses sont en faveur de l'efficacité des TCCp et de l'EMC ; la MERIT et la TMC ont fait l'objet d'études isolées pour leur efficacité.

Corrigendum: Does Cognitive Behavior Therapy for psychosis (CBTp) show a sustainable effect on delusions? A meta-analysis.

[This corrects the article DOI: 10.3389/fpsyg.2015.01450.].

Expressive suppression is associated with state paranoia in psychosis: An experience sampling study on the association between adaptive and maladaptive emotion regulation strategies and paranoia.

OBJECTIVES: Although emotional instability and problems in emotion regulation (ER) are known to be linked to the formation and maintenance of psychosis and paranoia, it remains unclear whether the use of specific ER strategies is associated with it. The first aim of the study was to explore the association between emotional instability and paranoia. The second and third aims were to investigate whether the use of maladaptive ER strategies leads to paranoia in patients with psychosis in daily life and whether the use of more adaptive ER strategies reduces paranoia. DESIGN: A prospective momentary assessment study over the course of 6 days was performed. METHOD: Participants with psychosis (n = 32) reported repeatedly over six consecutive days on the presence and instability of positive and negative emotions, their use of adaptive (reappraisal, acceptance, distraction, social sharing, reflection) and maladaptive ER strategies (rumination, expressive suppression) and momentary paranoia in their daily life. RESULTS: Hierarchical linear regression analysis revealed that patients with psychosis who presented pronounced instability of negative emotions showed more severe levels of state paranoia. In addition, patients with psychosis who used expressive suppression when confronted with negative emotions at one point in time presented more pronounced levels of state paranoia at the following point in time. CONCLUSION: The results presented here suggest that both emotional instability and the use of expressive suppression might cause state paranoia and thus add to our understanding of causal mechanisms related to paranoia such as instability of negative emotions and the use of less adaptive ER strategies. PRACTITIONER POINTS: Maladaptive emotion regulation strategies and more pronounced instability of negative emotions are relevant to paranoia in patients with psychosis and should be a special focus of CBTp interventions. Future interventions designed for patients suffering from paranoia should promote coping with unstable negative emotions and replacing or reducing maladaptive emotion regulation strategies with adaptive ones.