Emotion regulation and its neural correlates in the process of transition to psychosis

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The processes underlying transition into a first psychotic episode or relapse are not sufficiently well understood. Although a state of heightened emotionality precedes psychotic episodes we do not know why individuals fail to regulate these emotions effectively. The project aims to identify difficulties in emotion regulation (ER) that constitute the unknown links between stressors, negative emotions and psychotic symptoms in persons at risk of developing a first psychotic episode or relapse. The main aims are to explore whether difficulties in regulating emotion are associated with an increase in psychotic symptoms, to identify symptom-preventive regulation strategies, to reveal the role of corticolimbic structures in ER and to identify vulnerability factors that explain the difficulties in emotion regulation.Persons with prodromal symptoms of schizophrenia, psychotic symptoms, remitted symptoms, anxiety disorders and healthy controls will be compared with regard to their ability to regulate anxiety, sadness and anger. The project will involve conducting experiments in which negative emotions are induced and testing the effect of different ER-strategies on emotions, psycho-physiological reactions and symptoms. In addition functional magnetic resonance imaging (fMRI) will be employed to test whether difficulties in down-regulating distressing emotions are associated with stronger activations of corticolimbic structures including PFC and amygdala.Knowing whether individuals have difficulties in regulating their emotions in the pre-phase of a psychotic episode, understanding why these difficulties occur, and testing whether specific strategies are useful to prevent symptom increase is crucial in order to know which skills should be targeted in therapeutic interventions. The outcome of this project will therefore provide a substantial foundation for follow-up studies in prevention research and in the field of real-time fMRI studies on ER.