The Use of Adaptive Emotion Regulation Strategies in People with Attenuated Psychotic Symptoms – Results from a Two-Week Diary Study

Background: Prior research has shown that negative emotion constitutes a trigger for psychosis. This effect is further amplified by using maladaptive emotion regulation strategies. In contrast, the role of adaptive emotion regulation strategies is less clear despite its potential for informing interventions and prevention efforts. In this study, we investigated whether the decreased use of adaptive emotion regulation strategies in daily life is associated with an elevated risk of psychosis. Methods: Participants reporting a lifetime prevalence of attenuated psychotic symptoms (AS; n = 43) and comparison participants without attenuated psychotic symptoms (n = 40) completed a 14-day diary study with one daily assessment of adaptive emotion regulation (ER) strategies ranging from tolerance-based ER-strategies (e.g., understanding, constructively directing attention) to change-focused ER-strategies (e.g., modification, effective self-support). We tested for group differences in adaptive ER-strategies use with multilevel models. Results: AS used multiple tolerance-based adaptive ER-strategies (acceptance, understanding, clarity, directing attention) less frequently in daily life. However, only a single change-focused adaptive ER-strategy (modification) showed consistently lower utilization rates in AS. Conclusion: People with an elevated risk of psychosis use various adaptive ER-strategies focusing on comprehending and accepting negative emotions less frequently. Fostering these strategies with targeted interventions could promote resilience against transitioning into psychosis.