Cognitive emotion regulation strategies, alexithymia and dissociation in schizophrenia, a review and meta-analysis.

AIMS Many individuals with schizophrenia are reported to have maladaptive expression and processing of emotion. This may take the form of conscious and implicit processes. Potential regulatory processes underlying schizophrenia are reviewed. We aimed to estimate effect sizes, potential heterogeneity and publication bias across three areas of measurement: a range of cognitive emotion regulation strategies(1) (CERS), alexithymia and dissociation. METHOD Data were pooled from 47 case-control studies involving measures of experiential avoidance, attentional deployment, cognitive reappraisal, emotion management, dissociation and alexithymia. All studies were rated for quality, risk of bias and publication bias. RESULTS The following effect sizes (g) were observed: emotion management: 0.96 [0.77, 1.14] and cognitive reappraisal: 0.49 [0.32, 0.66] were negatively associated with schizophrenia. Experiential avoidance: -0.44 [-0.59, -0.29], attentional deployment -0.96 [-1.18, -0.75], dissociation: -0.86 [-1.13, -0.60] and alexithymia: -1.05 [-1.45, -0.65] were positively associated with schizophrenia. Subgroups of dissociation and attentional deployment were also analysed. Meta-analyses revealed potential publication bias and heterogeneity in the study of CERS in schizophrenia. CONCLUSIONS A marked difference in the implementation of CERS is associated with schizophrenia compared to controls. Dissociation variables and alexithymia are also indicated and may be implicated in adaptive cognitive emotional regulation. Theoretical and research implications are discussed.