Emotion awareness linked to social functioning in schizophrenia

By Mark Cowen

Emotion awareness and regulation deficits are significantly associated with reduced social functioning in patients with schizophrenia, research shows.

"Our results invite speculation about the potential to improve social dysfunction by ameliorating such deficits," comment David Kimhy (Columbia University, New York, USA) and colleagues in Psychiatry Research.

The findings come from a study of 44 patients with schizophrenia, aged an average of 30 years, and 20 mentally healthy controls, aged an average of 24 years. There were no significant differences between the groups regarding gender, ethnicity, and reading ability.

Emotion awareness was assessed using the Toronto Alexithymia Scale (TAS-20) questionnaire, emotion regulation using the Emotion Management Task (EMT) and the Emotion Regulation Questionnaire (ERQ), and social functioning using the Provision of Social Relations Scale (PSRS).

The team found that participants with schizophrenia displayed significant deficits in identifying and describing their emotions compared with controls, with TAS-20 subscale scores for "difficulty identifying feelings" and "difficulty describing feelings" of 19.67 versus 11.29 and 14.67 versus 9.47, respectively.

They also had a reduced ability to manage their emotions compared with controls, with EMT scores of 88.34 versus 101.80, and used significantly less reappraisal and more suppression to regulate their emotions, with ERQ "reappraisal" subscale scores of 26.77 versus 31.35, and ERQ "suppression" subscale scores of 16.36 versus 12.55.

Provision of Social Relations Scale scores were also significantly higher in schizophrenia patients compared with controls, at 37.31 versus 20.94, indicating poorer support and relationship quality.

Among the schizophrenia patients, greater social functioning was associated with an increased ability to identify and describe emotions, better emotion management, and greater use of reappraisal and less use of suppression.

Multiple regression analysis revealed that difficulty describing feelings accounted for 35% of the variance in social functioning, after accounting for age and neurocognitive functioning.

Kimhy et al conclude: "The present study highlights the importance of emotion awareness and regulation in schizophrenia, pointing to their substantial influence on social functioning above and beyond the impact of neurocognitive functioning."

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