朱傳林 李 萍 羅文波,2 齊正陽 何蔚祺

1 引言

精神分裂癥是一種復(fù)雜的精神疾病,它通常會(huì)給個(gè)體帶來社會(huì)功能障礙(Brekke,Hoe,&Green,2009),關(guān)于影響精神分裂癥患者社會(huì)功能障礙的早期研究主要集中在神經(jīng)認(rèn)知缺陷方面(Green,2007)。近年來,社會(huì)認(rèn)知已成為精神分裂癥研究的一個(gè)重要領(lǐng)域(Green&Leitman,2008),Fett等人(2011)的元分析結(jié)果表明,社會(huì)認(rèn)知與個(gè)體社會(huì)功能之間的聯(lián)系比神經(jīng)認(rèn)知更緊密。與此相對(duì)應(yīng)的是,美國國立精神衛(wèi)生研究所(NIMH,the National Institute of Mental Health of America)將社會(huì)認(rèn)知?jiǎng)澏榫穹至寻Y研究?jī)?yōu)先考慮的領(lǐng)域,還規(guī)定了5個(gè)優(yōu)先研究的基本研究領(lǐng)域：心理理論(theory of mind)、社會(huì)知覺(social perception)、社會(huì)知識(shí)(social knowledge)、歸因偏向(attribution bias)和情緒加工(emotion processing)(Green&Leitman,2008)。然而,上述5個(gè)領(lǐng)域并不是受到研究者同等程度的重視,相對(duì)而言,研究者們較少考慮精神分裂癥患者通過何種方式來加工、調(diào)節(jié)自身情緒,以及如何通過調(diào)節(jié)自身情緒對(duì)其社會(huì)功能產(chǎn)生影響。研究表明,健全的社會(huì)功能有賴于有效的情緒意識(shí)和情緒調(diào)節(jié)(Barch& Ceaser,2012;Kimhy et al.,2012;Renard,Pijnenborg,&Lysaker,2012)。關(guān)于精神分裂癥患者情緒加工的研究主要集中在對(duì)他人情緒面孔表情的感知與識(shí)別(Lar?i,Fonteneau,Mourad,&Raballo,2010),關(guān)于該類患者情緒調(diào)節(jié)的研究相對(duì)較少?；A(chǔ)情感科學(xué)對(duì)精神分裂癥患者情緒調(diào)節(jié)研究的迫切需求與臨床研究不足之間的矛盾已成為阻礙精神分裂癥社會(huì)認(rèn)知領(lǐng)域研究進(jìn)展的最大障礙(Green&Leitman,2008)。

通過谷歌學(xué)術(shù)檢索有關(guān)論述情緒調(diào)節(jié)模型的論文發(fā)現(xiàn),截至2015年7月,Gross關(guān)于情緒調(diào)節(jié)加工模型(the process model of emotion regulation)的兩篇論文(Gross,1998a,1998b)已被引用總計(jì)5301次(單篇引用次數(shù)分別為2177次和3124次),然而有關(guān)該領(lǐng)域其他較有代表性的模型,如Thayer等人(Thayer,Newman,&McClain,1994)的情緒自我調(diào)節(jié)模型、Parkinson和Totterdell(1999)的情緒調(diào)節(jié)策略分類模型、Larsen(2000)的情緒調(diào)節(jié)模型、Koole(2009)的分類模型的論文的引用次數(shù)相對(duì)較少,上述4篇文章的引用次數(shù)依次為634、313、574、416次。因而Gross提出的情緒調(diào)節(jié)加工模型可能是當(dāng)前認(rèn)可度最高的情緒調(diào)節(jié)模型,基于此,本文將結(jié)合Gross的情緒調(diào)節(jié)加工模型,擬從情緒調(diào)節(jié)的定義、精神分裂癥患者進(jìn)行情緒調(diào)節(jié)的必要性、不同情緒調(diào)節(jié)策略的特點(diǎn)及其對(duì)個(gè)體的影響、情緒調(diào)節(jié)的影響因素4個(gè)方面進(jìn)行系統(tǒng)回顧和總結(jié),并對(duì)未來研究予以展望。

2 情緒調(diào)節(jié)研究回顧

2.1 情緒調(diào)節(jié)的定義

情緒作為一種心理現(xiàn)象,在個(gè)體的日常生活中扮演著重要角色。研究者普遍認(rèn)為,情緒是由個(gè)體的主觀體驗(yàn)、行為表現(xiàn)(例如面部的、肢體的、言語的表現(xiàn))、生理反應(yīng)(包括中樞和外周生理反應(yīng))(Gross&Barrett,2011;Mauss,Levenson,McCarter,Wilhelm,&Gross,2005)等組成的。由于情緒涉及的范疇是多層次的,其中任何一個(gè)層次都可以成為個(gè)體進(jìn)行調(diào)節(jié)的對(duì)象,所以情緒調(diào)節(jié)也是一個(gè)復(fù)雜的多樣性系統(tǒng),這就加大了對(duì)情緒調(diào)節(jié)進(jìn)行定義的難度。與情緒一樣,情緒調(diào)節(jié)目前尚無統(tǒng)一的定義。Cole等人(Cole,Martin,&Dennis,2004)認(rèn)為,個(gè)體當(dāng)前的情緒狀態(tài)會(huì)對(duì)其在記憶或社會(huì)互動(dòng)等各種內(nèi)外在活動(dòng)中的心理歷程產(chǎn)生影響,這種影響過程就是情緒調(diào)節(jié)的過程。而在Gross等人(Gross,1998a,1998b;Gross,Sheppes,&Urry,2011)看來,當(dāng)個(gè)體特定的目標(biāo)被激活后,進(jìn)而上調(diào)或者下調(diào)某種情緒反應(yīng)的強(qiáng)度大小及其持續(xù)時(shí)間的長(zhǎng)短時(shí),情緒調(diào)節(jié)就發(fā)生了,情緒調(diào)節(jié)是指?jìng)€(gè)體試圖改變自身將要體驗(yàn)到的情緒種類(which)、在什么時(shí)候體驗(yàn)到此類情緒(when),以及個(gè)體是怎樣體驗(yàn)、表達(dá)此類情緒的(how)。前者強(qiáng)調(diào)的是情緒對(duì)個(gè)體認(rèn)知功能的影響,后者強(qiáng)調(diào)的是個(gè)體在強(qiáng)度和時(shí)間上對(duì)其情緒體驗(yàn)產(chǎn)生影響,更多地強(qiáng)調(diào)了個(gè)人的主觀能動(dòng)性。我們認(rèn)為,情緒調(diào)節(jié)指人們通過掌控自身將體驗(yàn)到哪種類型的情緒、在什么時(shí)候體驗(yàn)到該類情緒,并試圖改變即將體驗(yàn)到的情緒強(qiáng)度,進(jìn)而實(shí)現(xiàn)個(gè)人特定預(yù)期目標(biāo)所進(jìn)行的一系列活動(dòng)。

通常情況下,個(gè)體進(jìn)行情緒調(diào)節(jié)的內(nèi)容包括,減少負(fù)性情緒(例如,憤怒、焦慮等)體驗(yàn),增加正性情緒(例如高興、愉悅)體驗(yàn)。但是,在某些特定的條件下,個(gè)體也會(huì)嘗試著去增強(qiáng)負(fù)性情緒體驗(yàn)(例如,面臨人身威脅時(shí)的憤怒情緒),減少正性情緒體驗(yàn)(例如,在參加葬禮時(shí)突然想到喜劇電影想笑)(Gross,2013)。情緒調(diào)節(jié)包括以下3個(gè)核心特征：(1)減弱(增強(qiáng))某種負(fù)性(正性)情緒體驗(yàn)的強(qiáng)度或者是縮短(延長(zhǎng))其持續(xù)時(shí)間;(2)情緒調(diào)節(jié)可以是有意識(shí)進(jìn)行的,也可以是在無意識(shí)中進(jìn)行的;(3)不能籠統(tǒng)地判定某種情緒調(diào)節(jié)策略是絕對(duì)適應(yīng)良好(不良)的,因?yàn)樘囟ǖ那榫w調(diào)節(jié)策略是否有助于個(gè)體達(dá)成情緒調(diào)節(jié)目標(biāo),是由所處的環(huán)境條件(而不是由所采用的策略自身)來決定的(Jazaieri,Urry,&Gross,2013)。例如Hallam等人(2014)發(fā)現(xiàn),雖然使用表達(dá)抑制策略不利于自身的情緒調(diào)節(jié),但使用該策略調(diào)節(jié)他人的情緒時(shí),調(diào)節(jié)效果卻比較理想。雖然情緒調(diào)節(jié)的內(nèi)容和情緒調(diào)節(jié)的核心特征屬于不同維度的概念,二者之間存在諸多差異,但是也存在一些共同之處,如,情緒調(diào)節(jié)的內(nèi)容以及所使用的情緒調(diào)節(jié)策略本身無好壞之分,其屬性隨著環(huán)境的變化而變化。例如,通常情況下憤怒被認(rèn)為是負(fù)面情緒,不利于個(gè)體身心健康,但在面臨人身威脅的情況下,被激發(fā)的憤怒情緒有助于激活個(gè)體的防御體系,因而對(duì)個(gè)體生存發(fā)展具有積極意義;同時(shí),通常認(rèn)為使用抑制策略不利于個(gè)體身心健康,但在參加重要會(huì)議、葬禮等活動(dòng)時(shí),突然聯(lián)想到了讓人發(fā)笑的電影場(chǎng)景,此時(shí)抑制自身笑的沖動(dòng)就顯得尤為必要,因而不應(yīng)將二者完全割裂開來。

2.2 情緒調(diào)節(jié)策略種類的劃分

情緒調(diào)節(jié)策略的種類很多,相應(yīng)地,也有多種情緒調(diào)節(jié)策略劃分標(biāo)準(zhǔn)。例如,(1)根據(jù)是否會(huì)誘發(fā)各種心理障礙,可以劃分為非適應(yīng)性(maladaptive)策略和適應(yīng)性(adaptive)策略(Aldao&Dixon-Gordon,2014;Aldao,Nolen-Hoeksema,&Schweizer,2010),非適應(yīng)性的情緒調(diào)節(jié)策略更容易誘發(fā)各種心理障礙;(2)根據(jù)情緒調(diào)節(jié)策略和特定的情緒反應(yīng)傾向形成的時(shí)間順序,可以劃分為先行關(guān)注調(diào)節(jié)策略(前者的生成時(shí)間早于后者)和反應(yīng)關(guān)注調(diào)節(jié)策略(前者的生成時(shí)間晚于后者)(Gresham&Gullone,2012;Gross,2002);(3)根據(jù)在使用特定策略的過程中是否需要意志努力的參與,可以劃分為內(nèi)隱調(diào)節(jié)策略和外顯調(diào)節(jié)策略(Gyurak,Gross,&Etkin,2011);(4)根據(jù)個(gè)體進(jìn)行情緒調(diào)節(jié)時(shí)所激活的目標(biāo)是由自身還是他人激活的,可以分為內(nèi)在情緒調(diào)節(jié)策略和外在情緒調(diào)節(jié)策略(Gross,2013)。

上述4種劃分方法之間無絕對(duì)優(yōu)劣之分,但以是否會(huì)誘發(fā)各種心理障礙為劃分依據(jù),可以更好地與精神分裂癥患者的心理健康狀況聯(lián)系起來,因而與其他3種劃分依據(jù)相比,此種劃分方法更有現(xiàn)實(shí)臨床意義,基于此,本文將重點(diǎn)采用第一種分類依據(jù)。此外,以上列舉的是幾種較為常見的分類方法,在此需要指出的是,單就某一種分類方法而言,不同的情緒調(diào)節(jié)之間并不是完全對(duì)立的,二者在一定條件下可以轉(zhuǎn)化,以內(nèi)隱調(diào)節(jié)策略和外顯調(diào)節(jié)策略為例,外顯調(diào)節(jié)策略可以通過多次訓(xùn)練,逐步轉(zhuǎn)化為內(nèi)隱調(diào)節(jié)策略(Jackson et al.,2003;Mauss,Cook,Cheng,&Gross,2007)。例如,嬰兒通常沒有情緒意識(shí),更談不上有意識(shí)地使用各種策略來調(diào)節(jié)自身的情緒,隨著年齡的增長(zhǎng),小學(xué)中、高年級(jí)兒童在家長(zhǎng)及教師的指導(dǎo)下,會(huì)在某些情境下有意識(shí)地嘗試使用重評(píng)策略,但是對(duì)該策略的使用仍未達(dá)到熟練程度,到中學(xué)高年級(jí)、大學(xué)階段,當(dāng)個(gè)體需要進(jìn)行情緒調(diào)節(jié)時(shí),即便在缺乏各種內(nèi)、外在提醒的情況下,個(gè)體依然能在無意識(shí)條件下靈活運(yùn)用認(rèn)知重評(píng)策略進(jìn)行情緒調(diào)節(jié),這體現(xiàn)了個(gè)體認(rèn)知重評(píng)策略從無到有、從外顯到內(nèi)隱的演變過程。就幾種分類方法而言,它們之間也未必是絕對(duì)孤立的,彼此之間可能存在一定程度的重疊,因而同一種情緒調(diào)節(jié)策略,可以參與到多種不同分類之中。例如,既可以把重評(píng)策略歸為適應(yīng)性的情緒調(diào)節(jié)策略,也可以歸為先行關(guān)注策略?？傊?應(yīng)該根據(jù)實(shí)際需要,靈活地選用恰當(dāng)?shù)姆诸愐罁?jù),從而促進(jìn)個(gè)體進(jìn)行有效的情緒調(diào)節(jié)。

2.3 Gross的情緒調(diào)節(jié)加工模型簡(jiǎn)介

情緒的生成是一個(gè)動(dòng)態(tài)的發(fā)展過程,Gross根據(jù)不同情緒調(diào)節(jié)策略在情緒生成過程中發(fā)生主要影響的時(shí)間不同,將情緒調(diào)節(jié)依次劃分為5個(gè)組成部分：情境選擇(situation selection)、情境修正(situation modifications)、注意分配(attention deployment)、認(rèn)知改變(cognition change)、反應(yīng)調(diào)整(response modulation),這5個(gè)部分組成一個(gè)緊密聯(lián)系的整體,即為Gross的情緒調(diào)節(jié)加工模型(Gross,1998a;Gross&Jazaieri,2014)。情境選擇,指?jìng)€(gè)體判斷某種情境(人)可能會(huì)給個(gè)體帶來哪些影響,進(jìn)而選擇趨近還是回避該情境(人),情境選擇并不是個(gè)體的隨意行為,它往往包含了個(gè)體對(duì)情境的傾向性。例如,品學(xué)兼優(yōu)的學(xué)生更傾向于選擇和刻苦學(xué)習(xí)的學(xué)生一起學(xué)習(xí),而不是和不思進(jìn)取的學(xué)生一起玩游戲。情境修正,指?jìng)€(gè)體試圖通過修正和改變誘發(fā)特定情緒的情境的某個(gè)(些)方面和特點(diǎn),進(jìn)而使情緒發(fā)生改變所進(jìn)行的活動(dòng)。例如,學(xué)生在復(fù)習(xí)功課時(shí),為了創(chuàng)造安靜的學(xué)習(xí)環(huán)境,選擇關(guān)掉音樂,而不是一邊學(xué)習(xí)一邊聽音樂,便是使用情境修正策略。情境選擇和情境修正都需要個(gè)體改變所處的環(huán)境,但是,在不改變情境的前提下,個(gè)體也可以進(jìn)行有效的情緒調(diào)節(jié),因?yàn)榍榫车牟煌矫婢哂胁煌饬x,個(gè)體可以通過調(diào)整自己的注意來干預(yù)情緒的生成過程(孟昭蘭,2005)。注意分配,指?jìng)€(gè)體對(duì)其所關(guān)注的內(nèi)容進(jìn)行調(diào)節(jié)或者把注意從當(dāng)前情境中轉(zhuǎn)移開來(邢采, 楊苗苗,2013)。Gross(1998b)認(rèn)為, 注意分配策略包括：專心(concentration)、分心(distraction)和沉思(rumination),專心指?jìng)€(gè)體長(zhǎng)時(shí)間地將注意力集中于某一特定任務(wù)或情境事件,分心則指將注意力分配到與情緒無關(guān)的方面,或者將注意力完全從當(dāng)前情境中轉(zhuǎn)移。沉思是指?jìng)€(gè)體將注意力集中于個(gè)人感受或者事件可能導(dǎo)致的結(jié)果上。例如,學(xué)生為了獲取理想的成績(jī),選擇遠(yuǎn)離游戲、集中精力認(rèn)真復(fù)習(xí)便是使用專心策略的表現(xiàn),而邊看電視邊看書通常是分心的體現(xiàn)。認(rèn)知改變,個(gè)體改變固有的思維方式,重新評(píng)價(jià)可能會(huì)影響自身情緒的環(huán)境或自身掌控環(huán)境的能力。每種情境都可以被賦予不同含義,對(duì)不同意義的確認(rèn)與選擇,可以改變情緒生成過程,進(jìn)而實(shí)現(xiàn)情緒調(diào)節(jié)的目標(biāo)。例如,高考、考研等大型考試原本是一種淘汰性考試,但是個(gè)體也可以將其視為僅僅是對(duì)自身知識(shí)掌握程度的考查,進(jìn)而緩解考試可能帶來的壓力。反應(yīng)調(diào)整,特定情緒生成后,個(gè)體對(duì)該情緒可能誘發(fā)的主觀心理感受、生理體驗(yàn)以及外在的行為表達(dá)進(jìn)行干預(yù),進(jìn)而改變情緒體驗(yàn)的類型或者情緒體驗(yàn)的強(qiáng)弱程度(孟昭蘭,2005)。

對(duì)比上述5種策略,不難發(fā)現(xiàn),個(gè)體可以通過操作輸入系統(tǒng)(先行關(guān)注情緒調(diào)節(jié))與輸出系統(tǒng)(反應(yīng)關(guān)注情緒調(diào)節(jié))來調(diào)節(jié)情緒,根據(jù)個(gè)體是否已經(jīng)形成特定的情緒反應(yīng)傾向,可以將反應(yīng)傾向形成之前的情境選擇、情境修正、注意分配、認(rèn)知改變劃分為先行關(guān)注情緒調(diào)節(jié),而反應(yīng)調(diào)整(此時(shí)特定的反應(yīng)傾向已經(jīng)形成)則屬于反應(yīng)關(guān)注情緒調(diào)節(jié)(Gross,1998a)。先行關(guān)注情緒調(diào)節(jié)首要關(guān)注的是特定的情緒反應(yīng)傾向是否被觸發(fā),而反應(yīng)關(guān)注情緒調(diào)節(jié)強(qiáng)調(diào)的是,可以通過何種方式來調(diào)整已經(jīng)形成的情緒反應(yīng)傾向,前者的典型代表是認(rèn)知重評(píng)(cognitive reappraisal)策略,后者的典型代表是表達(dá)抑制(expressive suppression)策略,認(rèn)知重評(píng)是指?jìng)€(gè)體改變?cè)械慕忉屇撤N特定情境的方式,進(jìn)而降低該事件對(duì)個(gè)體的影響;表達(dá)抑制指?jìng)€(gè)體主動(dòng)地掩藏由情緒體驗(yàn)誘發(fā)的內(nèi)部情緒體驗(yàn)的外在表現(xiàn)(Gross,2002)。此外,上述5種策略之間的順序不可調(diào)換,但是在日常生活中個(gè)體通常會(huì)同時(shí)采取幾種不同策略(而不是單獨(dú)的使用某一種策略)來進(jìn)行情緒調(diào)節(jié)(Gross&Jazaieri,2014)。個(gè)體依次執(zhí)行完情境選擇、情境修正、注意分配、認(rèn)知改變、反應(yīng)調(diào)整策略之后,只是意味著一個(gè)情緒調(diào)節(jié)周期的完成,這并不代表整個(gè)情緒調(diào)節(jié)過程的終結(jié),因?yàn)樵谀承┣榫硹l件下,個(gè)體需要通過多個(gè)情緒調(diào)節(jié)周期的循環(huán),才能實(shí)現(xiàn)最終的情緒調(diào)節(jié)目標(biāo)。此時(shí),第一個(gè)情緒調(diào)節(jié)周期完成之后,之后的每一輪新的情緒調(diào)節(jié)周期依然是從執(zhí)行情境選擇開始的(Strauss et al.,2013)。

3 為什么要關(guān)注精神分裂癥患者的情緒調(diào)節(jié)

3.1 情緒調(diào)節(jié)影響個(gè)體的身心健康

由情緒的定義可知,不同情緒均會(huì)伴隨有相應(yīng)的生理反應(yīng),而這些生理反應(yīng)是與個(gè)體的身體健康緊密聯(lián)系在一起的。例如,Suls和Bunde(2005)發(fā)現(xiàn),高水平的負(fù)性情緒體驗(yàn)預(yù)示著更嚴(yán)重的心血管疾病。不僅情緒反應(yīng)本身會(huì)影響個(gè)體的身體健康,情緒調(diào)節(jié)也會(huì)對(duì)個(gè)體的身體健康造成影響。一項(xiàng)追蹤研究(Kubzansky,Park,Peterson,Vokonas,&Sparrow,2011)表明,在控制了傳統(tǒng)的可能誘發(fā)冠心病的因素之后,通過成功的情緒調(diào)節(jié),可以預(yù)測(cè)出個(gè)體患冠心病的風(fēng)險(xiǎn)將顯著下降。對(duì)于具體情緒調(diào)節(jié)策略而言,有研究者(Robert,Levenson,&Gross,2008)發(fā)現(xiàn),使用抑制策略會(huì)導(dǎo)致個(gè)體心血管系統(tǒng)的激活增強(qiáng),也有研究者(Giuliani,Drabant,Bhatnagar,&Gross,2011)指出,個(gè)體使用表達(dá)抑制策略的頻率和其前腦容量大小之間存在正相關(guān),還有研究者(Drabant,McRae,Manuck,Hariri,&Gross,2009)認(rèn)為,認(rèn)知重評(píng)策略既可以削弱個(gè)體腹側(cè)情感生成區(qū)的激活,還可以增強(qiáng)前額葉區(qū)的激活?？傊?情緒體驗(yàn)以及相應(yīng)的情緒調(diào)節(jié)都會(huì)對(duì)個(gè)體的身體健康產(chǎn)生積極或消極的影響。

還有研究表明,情緒調(diào)節(jié)會(huì)影響個(gè)體的心理健康。Hu等人(2014)的元分析結(jié)果表明,認(rèn)知重評(píng)策略與心理健康的積極指標(biāo)之間存在正相關(guān),與心理健康的消極指標(biāo)之間存在負(fù)相關(guān),對(duì)于表達(dá)抑制策略而言,結(jié)果正好相反。此外,Koole(2009)也指出,情緒調(diào)節(jié)失敗甚至還會(huì)誘發(fā)一些精神疾病。這就表明,不同類別的情緒調(diào)節(jié)策略會(huì)對(duì)個(gè)體心理健康水平產(chǎn)生不同性質(zhì)的影響。已有研究中,研究者更多的是將研究興趣集中于探討情緒調(diào)節(jié)對(duì)社會(huì)焦慮癥(SAD,Social Anxiety Disorder)(Aldao,Jazaieri,Goldin,&Gross,2014;Boden et al.,2012;Goldin et al.,2013;Werner,Goldin,Ball,Heimberg,&Gross,2011;Wong,Morrison,Heimberg,Goldin,&Gross,2014)、雙相障礙(BD,Bipolar Disorder)(Gruber,Harvey,&Gross,2012;Gruber,Hay,&Gross,2014;Townsend&Altshuler,2012)、抑郁(Depression)(Ehring,Tuschen-Caffier,Schnülle,Fischer,&Gross,2010;McRae,Rekshan,Williams,Cooper,&Gross,2014;Opitz,Gross,&Urry,2012)、創(chuàng)傷后應(yīng)激障礙(PTSD,Posttraumatic Stress Disorder)(Boden et al.,2013;Reber et al.,2013)以及自閉癥(Autism)(Samson,Huber,&Gross,2012;Weiss,Thomson,&Chan,2014)的影響,鮮有研究探討情緒調(diào)節(jié)對(duì)精神分裂癥的影響。

3.2 精神分裂癥患者的情緒感知與表達(dá)異常

精神分裂癥患者的情緒出現(xiàn)異常主要體現(xiàn)在其情緒體驗(yàn)、情緒感知、情緒刺激加工速度、情緒表達(dá)以及與情緒相關(guān)的生理反應(yīng)等方面。首先,精神分裂癥患者的情緒體驗(yàn)存在異常。有研究(Hooker et al.,2014;Sanchez,Lavaysse,Starr,&Gard,2014)發(fā)現(xiàn),精神分裂癥患者比健康人群有更多的負(fù)性情緒體驗(yàn),更少的正性情緒體驗(yàn),也有研究(Hooker et al.,2014;Ritsner,Arbitman,&Lisker,2011;Trémeau,2006)發(fā)現(xiàn), 精神分裂癥患者和健康人群的正性情緒體驗(yàn)水平之間無顯著差異,但是,精神分裂癥患者的負(fù)性情緒體驗(yàn)水平和健康人群相近,甚至高于健康人群。上述差異可能是由采用不同研究方法造成的：Hooker等人(2014)以及Sanchez等人(2014)的結(jié)論是基于實(shí)證研究得出的,而Trémeau(2006)的結(jié)論則是在元分析的基礎(chǔ)上得出的。由此可見,盡管研究者沒有對(duì)精神分裂癥患者是否比健康人群有更少的正性情緒體驗(yàn)達(dá)成共識(shí),但大都認(rèn)為其負(fù)性情緒體驗(yàn)普遍高于健康人群,說明其情緒體驗(yàn)異于常人。其次,精神分裂癥患者情緒感知方面的異常表現(xiàn)為,該類患者能較好地區(qū)分各種不同的負(fù)性情緒,但是卻不能很好地將正性情緒從負(fù)性情緒中辨別出來(Kimhy et al.,2014)。且該類患者的情緒感知能力存在性別差異,具體表現(xiàn)為,男性識(shí)別積極情緒的能力顯著弱于健康人群,女性患者識(shí)別積極、消極面孔情緒的能力與健康個(gè)體相當(dāng),即男性精神分裂癥患者比女性患者存在更嚴(yán)重的面部情緒識(shí)別障礙(Erol,Putgul,Kosger,&Ersoy,2013)。精神分裂癥患者情緒感知方面的缺陷還表現(xiàn)為,在日常人際交往過程中,此類患者不能有效地感知他人的情緒(Fett,Viechtbauer,Penn,van Os,&Krabbendam,2011;Vance,Dodson,Watkins,Kennedy,&Keltner,2013)。第三,加工相同的情緒刺激,精神分裂癥患者耗費(fèi)的時(shí)間比控制組長(zhǎng),這會(huì)使他們的高級(jí)認(rèn)知能力和情緒調(diào)節(jié)加工過程受到限制,進(jìn)而影響其自我情緒調(diào)節(jié)能力的發(fā)揮(Lee et al.,2013;Wexler,Ikezawa,&Corbera,2014),該類人群的這種不足貫穿于情緒刺激加工的早、中、晚等不同階段(Jahshan et al.,2014)。第四,精神分裂癥患者的情緒表達(dá)存在異常。Trémeau(2006)的一項(xiàng)綜述表明：與健康人群相比,精神分裂癥患者公開的言語表達(dá)、面部表情明顯較少。O'Driscoll,Laing和Mason(2014)的元分析結(jié)果也表明：與健康人群相比,精神分裂癥患者存在述情障礙(Alexithymia,個(gè)體識(shí)別和描述自己情緒狀態(tài)方面的能力存在缺陷)。而Sanchez等人(2014)首次發(fā)現(xiàn),精神分裂癥患者的情緒表達(dá)存在負(fù)性情緒環(huán)境不一致效應(yīng),即該類患者傾向于在正性環(huán)境條件下表達(dá)出負(fù)性情緒,這明顯異于健康個(gè)體。此外,精神分裂癥患者存在與情緒相關(guān)的生理反應(yīng)方面的缺陷。近期的一項(xiàng)fMRI研究表明,精神分裂癥患者在重評(píng)負(fù)性情緒圖片時(shí),腦島、腹外側(cè)前額葉皮層、顳中回、尾狀核以及丘腦的激活顯著地弱于健康人群(van der Meer et al.,2014)。

精神分裂癥患者還存在情緒學(xué)習(xí)方面的異常。情緒學(xué)習(xí)也可以稱作聯(lián)結(jié)學(xué)習(xí),即個(gè)體根據(jù)已有經(jīng)驗(yàn),賦予刺激物情感意義的過程(Murakoshi&Saito,2009;Pizzagalli,Greischar,&Davidson,2003)。經(jīng)典的情緒聯(lián)結(jié)學(xué)習(xí)主要包括一個(gè)條件刺激和一個(gè)厭惡刺激,二者進(jìn)行聯(lián)結(jié),表現(xiàn)為,在情緒學(xué)習(xí)過程中,給個(gè)體同時(shí)呈現(xiàn)中性刺激(例如,光、聲音等)和情緒性刺激(例如,美味的食物),讓個(gè)體通過學(xué)習(xí)來判斷當(dāng)中性刺激出現(xiàn)時(shí)應(yīng)該出現(xiàn)情緒信息(積極信息和消極信息)還是非情緒信息(中性信息),特定聯(lián)結(jié)關(guān)系建立后,單獨(dú)呈現(xiàn)中性刺激也可以誘發(fā)個(gè)體的情緒反應(yīng)(Pizzagalli et al.,2003)。情緒學(xué)習(xí)會(huì)指導(dǎo)個(gè)體對(duì)環(huán)境中的刺激作出趨近或回避反應(yīng),對(duì)個(gè)體生存與發(fā)展具有重要意義(Stussi,Brosch,&Sander,2015)。精神分裂癥患者的情緒學(xué)習(xí)方面的缺陷表現(xiàn)為,該類個(gè)體能成功地完成性別–物體匹配任務(wù)(Exner,Boucsein,Degner,Irle,&Weniger,2004),卻不能順利完成情緒–物體匹配任務(wù),尤其是不能準(zhǔn)確區(qū)分正、負(fù)性情緒(Exner et al.,2004;Namiki et al.,2007),鑒于杏仁核在情緒學(xué)習(xí)和記憶中扮演著重要角色(Maren,1999;Morris,?hman,&Dolan,1998;Rodrigues,Schafe,&LeDoux,2004),該類患者的情緒學(xué)習(xí)缺陷或許與他們的杏仁核體積比健康人群小有關(guān),至于是否存在導(dǎo)致此類患者情緒學(xué)習(xí)缺陷的其他潛在因素,則有待于進(jìn)一步探討。

3.3 精神分裂癥患者情緒調(diào)節(jié)的干預(yù)研究

有關(guān)精神分裂癥患者情緒調(diào)節(jié)方面的研究不僅起步較晚,而且所使用到的情緒調(diào)節(jié)策略也十分有限,主要集中于研究表達(dá)抑制和認(rèn)知重評(píng)這兩種策略對(duì)精神分裂癥患者情緒調(diào)節(jié)造成的影響(Henry,Rendell,Green,McDonald,&O'Donnell,2008;Horan,Hajcak,Wynn,&Green,2013;Kimhy et al.,2012;Perry,Henry,&Grisham,2011;Strauss et al.,2013,2015;van der Meer et al.,2014;van der Meer,van’t Wout,&Aleman,2009), 也有少數(shù)研究揭示了接受(Perry,Henry,Nangle,&Grisham,2012;Vilardaga,Hayes,Atkins,Bresee,&Kambiz,2013)、沉思(Thomas,Ribaux,&Phillips,2014)等策略在精神分裂癥患者情緒調(diào)節(jié)過程中所起的作用。基于重評(píng)和抑制在各種情緒調(diào)節(jié)策略中的重要地位,現(xiàn)將這兩種策略對(duì)個(gè)體的影響,從情感、認(rèn)知、社會(huì)三個(gè)角度對(duì)比如下。

首先,情感上,表現(xiàn)在情緒體驗(yàn)和情緒意識(shí)兩個(gè)方面。重評(píng)策略可以增加個(gè)體的積極情緒體驗(yàn),減少個(gè)體的消極情緒體驗(yàn),而抑制策略強(qiáng)調(diào)更多的是削弱個(gè)體的積極情緒體驗(yàn),增強(qiáng)個(gè)體的消極情緒體驗(yàn)(Aldao et al.,2010;Chambers,Gullone,&Allen,2009;Gross,2002;Henry et al.,2008);重評(píng)策略不會(huì)削弱個(gè)體的情緒表達(dá),而抑制策略則會(huì)削弱個(gè)體的情緒表達(dá)(Gross,2002);此外,Kimhy等人(2012)發(fā)現(xiàn)：精神分裂癥患者使用認(rèn)知重評(píng)策略時(shí),其情緒意識(shí)不會(huì)被削弱,而當(dāng)該類個(gè)體頻繁使用表達(dá)抑制策略時(shí),其情緒意識(shí)則會(huì)在較大程度上被削弱。其次,認(rèn)知上,重評(píng)策略只消耗少量認(rèn)知資源,而且不會(huì)削弱(或者只是在較低程度上削弱)個(gè)體的記憶成績(jī),而抑制策略則會(huì)消耗較多認(rèn)知資源,并且對(duì)個(gè)體的記憶效果造成較大的負(fù)面影響(Chambers et al.,2009;Gross,2002;Henry et al.,2008);使用重評(píng)策略只會(huì)輕微影響個(gè)體正在進(jìn)行的任務(wù)的效率,而抑制策略則會(huì)嚴(yán)重影響個(gè)體完成正在進(jìn)行的任務(wù)的效率(Henry et al.,2008)。第三,社會(huì)功能上,重評(píng)策略可以帶給個(gè)體更多的社會(huì)支持、提高個(gè)體的受歡迎程度、增強(qiáng)個(gè)體的社會(huì)功能、提升個(gè)體的幸福感、有助于幫助個(gè)體建立親密關(guān)系,而抑制策略則會(huì)在上述因素中,帶給個(gè)體與重評(píng)策略相反的影響(Aldao et al.,2010;Chambers et al.,2009;Gross,2002;Kimhy et al.,2012)?？傊?重評(píng)策略帶給個(gè)體更多正面影響,抑制策略則帶給個(gè)體更多負(fù)面影響。需要注意的是,雖然總體上重評(píng)策略的調(diào)節(jié)效果優(yōu)于抑制策略,但是這并不意味著抑制策略是無用的,特別是在重評(píng)策略或者其他策略無法發(fā)揮作用的情況下,抑制策略也可能會(huì)帶來較理想的調(diào)節(jié)效果(John&Gross,2004;van der Meer et al.,2009)。精神分裂癥患者認(rèn)知、情感、社會(huì)功能上的不足與缺陷,與其傾向于使用抑制策略是分不開的。

3.4 精神分裂癥患者的情緒調(diào)節(jié)存在異常

3.4.1 精神分裂癥患者情緒調(diào)節(jié)存在異常的表現(xiàn)

大量研究(Fan et al.,2013;Kimhy et al.,2012;Morris,Sparks,Mitchell,Weickert,&Green,2012;Horan et al.,2013;Strauss et al.,2013)表明,精神分裂癥患者的情緒調(diào)節(jié)存在異常。例如,O'Driscoll等人(2014)的元分析結(jié)果顯示,與健康個(gè)體相比,精神分裂癥患者傾向于更多地使用非適應(yīng)性情緒調(diào)節(jié)策略,具體表現(xiàn)為：與健康人群相比,該類患者較少使用認(rèn)知重評(píng)策略,他們更傾向于使用表達(dá)抑制策略(van der Meer et al.,2009)。最新研究(Grezellschak,Lincoln,&Westermann,2015)表明,過多使用適應(yīng)不良的情緒調(diào)節(jié)策略易誘發(fā)精神疾病,習(xí)慣使用適應(yīng)性情緒調(diào)節(jié)策略有利于阻止精神疾病的生成。認(rèn)知重評(píng)和表達(dá)抑制分別是Gross情緒調(diào)節(jié)加工模型中適應(yīng)性/先行關(guān)注調(diào)節(jié)策略和非適應(yīng)性/反應(yīng)關(guān)注調(diào)節(jié)策略的典型代表(Chambers et al.,2009;Mitchell,2011),過多地使用抑制策略會(huì)使精神分裂癥患者的幻聽體驗(yàn)頻率更高,使其日常社會(huì)功能越來越弱(Badcock,Paulik,&Maybery,2011)。判斷個(gè)體傾向于使用重評(píng)策略還是抑制策略,可以通過情緒調(diào)節(jié)問卷(Emotion Regulation Questionnaire)(Gross&John,2003)來測(cè)量。

適應(yīng)性情緒調(diào)節(jié)策略是指?jìng)€(gè)體選擇并執(zhí)行適用于特定環(huán)境,并且有助于實(shí)現(xiàn)個(gè)體的長(zhǎng)期目標(biāo)的情緒調(diào)節(jié)策略(Berenbaum,Raghavan,Le,Vernon,&Gomez,2003;Gross&John,2003;Mennin&Farach,2007),它會(huì)最大限度地減少個(gè)體的負(fù)性情緒體驗(yàn)(Bridges,Denham,&Ganiban,2004)。常見的適應(yīng)性情緒調(diào)節(jié)策略有重評(píng)、接受、問題解決、積極關(guān)注、計(jì)劃、正向重新調(diào)整和正向再評(píng)價(jià)等(Westermann,Boden,Gross,&Lincoln,2013)。非適應(yīng)性情緒調(diào)節(jié)策略是指不利于個(gè)體目標(biāo)實(shí)現(xiàn),有損個(gè)體身心健康的情緒調(diào)節(jié)策略(Aldao&Nolen-Hoeksema,2012;Malik,Wells,&Wittkowski,2015)。非適應(yīng)性的情緒調(diào)節(jié)策略有抑制、回避、沉思、自責(zé)、責(zé)備他人等(Aldao et al.,2010;Fletcher,Parker,Bayes,Paterson,&McClure,2014;Vanderhasselt et al.,2014)。大量研究表明,適應(yīng)性情緒調(diào)節(jié)策略和非適應(yīng)性情緒調(diào)節(jié)策略會(huì)給個(gè)體帶來不同的影響。首先,前者會(huì)使個(gè)體的負(fù)性情緒體驗(yàn)減少(Egloff,Schmukle,Burns,&Schwerdtfeger,2006;Hofmann,Friese,&Roefs,2009)、人際關(guān)系更和諧(Richards&Gross,2000)、適應(yīng)不良的心臟活動(dòng)減弱(Campbell-Sills,Barlow,Brown,&Hofmann,2006),而后者則會(huì)使個(gè)體的負(fù)性體驗(yàn)增加(Campbell-Sills et al.,2006;Ehring et al.,2010;Subic-Wrana et al.,2014)、記憶困難(Richards,Butler,&Gross,2003)、交感神經(jīng)激活增強(qiáng)(Gross&Levenson,1993;Wegner,Broome,&Blumberg,1997)、自主神經(jīng)系統(tǒng)的靈活性降低(Hofmann et al.,2005)。其次,個(gè)體使用非適應(yīng)性情緒調(diào)節(jié)策略的頻率和患精神性疾病的概率之間存在正相關(guān),而使用適應(yīng)性情緒調(diào)節(jié)策略的頻率和患精神病理學(xué)疾病的概率之間存在負(fù)相關(guān)(Aldao&Nolen-Hoeksema,2012;Aldao et al.,2010),不能熟練使用適應(yīng)性情緒調(diào)節(jié)策略的個(gè)體患精神疾病的風(fēng)險(xiǎn)會(huì)增加(McLaughlin,Hatzenbuehler,Mennin,&Nolen-Hoeksema,2011;Petermann&Kullik,2011;Schipper&Petermann,2013),這也說明非適應(yīng)性情緒調(diào)節(jié)策略對(duì)精神病理學(xué)疾病具有更好的預(yù)測(cè)力。此外,這兩種策略的使用不但會(huì)給精神分裂癥患者帶來影響,也會(huì)對(duì)其他精神病理學(xué)疾病產(chǎn)生影響,如抑郁癥、雙相障礙、自閉癥等(McRae et al.,2014;Townsend&Altshuler,2012;Weiss et al.,2014)。

3.4.2 精神分裂癥患者情緒調(diào)節(jié)存在異常的潛在誘因

精神分裂癥患者情緒調(diào)節(jié)異常是各種主客觀因素共同作用的結(jié)果。導(dǎo)致精神分裂癥患者情緒調(diào)節(jié)異常的客觀因素包括特定腦區(qū)的功能強(qiáng)弱、基因與遺傳、個(gè)體成長(zhǎng)的環(huán)境及成長(zhǎng)經(jīng)歷、陰性癥狀的嚴(yán)重程度等等。de Achával等人(2013)發(fā)現(xiàn),健康個(gè)體在完成道德判斷任務(wù)過程中伴隨地情緒調(diào)節(jié)會(huì)激活顳頂聯(lián)合區(qū)附近的腦區(qū)、前扣帶回以及腦島,而精神分裂患者完成同樣的任務(wù)時(shí),上述腦區(qū)卻沒有被激活。Tan,Ahmad,Loureiro,Zunder和Laviolette(2014)發(fā)現(xiàn),與健康個(gè)體相比,精神分裂癥患者的內(nèi)側(cè)前額葉皮層(medial prefrontal cortex,PFC)、杏仁核基底外側(cè)核(basolateral nucleus of the amygdale,BLA)和杏仁核的發(fā)展都出現(xiàn)了異常,而這3個(gè)腦區(qū)在情緒調(diào)節(jié)過程中扮演著重要角色。Vercammen等人(2013)發(fā)現(xiàn),健康男性抑制對(duì)負(fù)性情緒刺激的反應(yīng)時(shí),額中回激活水平會(huì)顯著提高,但精神分裂癥患者完成相同任務(wù)時(shí),其額中回卻沒有顯著激活。Mothersill等人(2014)首次從基因?qū)用娼沂玖司穹至寻Y患者情緒調(diào)節(jié)異常的原因,通過檢測(cè)精神分裂癥的某種誘發(fā)基因(rs1625579),他們發(fā)現(xiàn),精神分裂癥患者的右側(cè)杏仁核和與情緒加工以及情緒調(diào)節(jié)相關(guān)的額葉區(qū)域(如扣帶回和前額皮層)之間的功能連接比健康個(gè)體更強(qiáng)。城市居民的杏仁核活動(dòng)水平高于農(nóng)村居民,農(nóng)村居民的前扣帶回膝部比城市居民更活躍,而后者會(huì)嚴(yán)重影響杏仁核在情緒調(diào)節(jié)過程中發(fā)揮的作用(Lederbogen et al.,2011;van Os,Kenis,&Rutten,2010)。Burrus(2013)發(fā)現(xiàn), 兒童期遭受的虐待經(jīng)歷會(huì)導(dǎo)致個(gè)體的海馬發(fā)育出現(xiàn)異常,這種異常會(huì)直接影響背外側(cè)前額皮層 (負(fù)責(zé)情緒調(diào)節(jié)、認(rèn)知重評(píng)、一般性的執(zhí)行功能)的發(fā)展,因而可以推測(cè),精神分裂癥患者情緒調(diào)節(jié)異常可能是他們?cè)趦和诮?jīng)歷過虐待。此外,Daros,Ruocco,Reilly,Harris和 Sweeney(2014)發(fā)現(xiàn),發(fā)病期(陰性癥狀較嚴(yán)重)的精神分裂癥患者難以識(shí)別與調(diào)節(jié)悲傷的面部表情,而經(jīng)過治療之后(陰性癥狀較輕微),該類患者卻可以成功地識(shí)別、調(diào)節(jié)悲傷表情,因而表明陰性癥狀嚴(yán)重程度也會(huì)影響精神分裂癥患者的情緒調(diào)節(jié)。

主觀而言,我們認(rèn)為這種異常主要是由于該類患者未能正確對(duì)待適應(yīng)性情緒調(diào)節(jié)策略與非適應(yīng)性情緒調(diào)節(jié)策略對(duì)人們?cè)斐傻牟煌绊懰?。第?與非適應(yīng)性情緒調(diào)節(jié)策略相比,雖然適應(yīng)性情緒調(diào)節(jié)策略通常更有利于促進(jìn)個(gè)體進(jìn)行有效的情緒調(diào)節(jié),但是,非適應(yīng)性情緒調(diào)節(jié)策略的存在比適應(yīng)性情緒調(diào)節(jié)策略的缺失更不利于個(gè)體情緒調(diào)節(jié)目標(biāo)的實(shí)現(xiàn)(Aldao et al.,2010)。第二,不應(yīng)籠統(tǒng)地將某一情緒調(diào)節(jié)策略劃分為適應(yīng)良好或者適應(yīng)不良的,因?yàn)樘囟ㄇ榫w調(diào)節(jié)策略是適應(yīng)性的還是非適應(yīng)性的,不是由該策略自身決定的,而是由使用該策略的個(gè)體、需要調(diào)節(jié)的目標(biāo)情緒,以及個(gè)體當(dāng)時(shí)所處的具體環(huán)境等因素共同作用的結(jié)果(Gross,2002;Gross&Jazaieri,2014)。例如,Brummer,Stopa和Bucks(2014)發(fā)現(xiàn),年輕人使用抑制策略時(shí),其負(fù)性情緒體驗(yàn)會(huì)增強(qiáng),但是,老年人使用該策略時(shí),其負(fù)性情緒體驗(yàn)卻沒有增強(qiáng),此外,盡管程利等人(程利,袁加錦,何媛媛,李紅,2009)在一項(xiàng)綜述中指出：與認(rèn)知重評(píng)策略相比,表達(dá)抑制策略不利于改善個(gè)體的身心健康。但Brummer等人(2014)發(fā)現(xiàn)表達(dá)抑制策略可以有效地幫助老年人緩解壓力事件造成的影響,有利于提高其心理健康水平。第三,適應(yīng)性情緒調(diào)節(jié)策略和非適應(yīng)性情緒調(diào)節(jié)策略并不是彼此對(duì)立、孤立的,二者共同存在于一個(gè)從適應(yīng)不良到適應(yīng)良好的連續(xù)體之中,通常意義上的適應(yīng)良好與適應(yīng)不良正是這一連續(xù)體的兩個(gè)端點(diǎn)。情緒調(diào)節(jié)策略的適應(yīng)性具有可塑性(而不是一成不變的)(張晶等,2014),輔以合理訓(xùn)練之后,非適應(yīng)性情緒調(diào)節(jié)策略可以逐步過渡為適應(yīng)性情緒調(diào)節(jié)策略。這種觀點(diǎn)的提出是有依據(jù)的：在論述內(nèi)隱情緒調(diào)節(jié)策略和外顯情緒調(diào)節(jié)策略之間的關(guān)系時(shí),Gyurak和Mauss等人主張將情緒調(diào)節(jié)策略視作是從外顯調(diào)節(jié)逐步過渡到內(nèi)隱調(diào)節(jié)的連續(xù)體(Gyurak et al.,2011;Mauss,Bunge,&Gross,2007)。還有研究者(Gyurak et al.,2011;Jackson et al.,2003)認(rèn)為,情緒調(diào)節(jié)策略的屬性可以隨著時(shí)間和環(huán)境的變化而改變,并且這種改變帶有指向性,通常表現(xiàn)為外顯調(diào)節(jié)策略可以通過重復(fù)訓(xùn)練進(jìn)而逐步內(nèi)隱化。此外,精神分裂癥患者的情緒調(diào)節(jié)異于常人也可能是因?yàn)樗麄兇嬖谡J(rèn)知控制能力、同理心方面的缺陷,表現(xiàn)為當(dāng)要求觀看刺激物的非情緒性特征時(shí),控制組的LPP波幅會(huì)降低,而該類患者在完成相同任務(wù)時(shí),其LPP波幅卻沒有降低(Strauss et al.,2015);概率患者同理心方面的缺陷表現(xiàn)為他們不能很好地感知他人的情緒狀態(tài)(Lehmann et al.,2014)?；谝陨霞僭O(shè),輔以合理的治療手段,將精神分裂癥患者非適應(yīng)性的情緒調(diào)節(jié)策略逐步轉(zhuǎn)化為適應(yīng)性的情緒調(diào)節(jié)策略具有極大的可行性,這對(duì)臨床治療是十分重要的,至于可以通過哪些方法、技術(shù)手段來實(shí)現(xiàn)這種轉(zhuǎn)變,正是當(dāng)前研究中亟待解決的一大難題。

4 精神分裂癥患者情緒調(diào)節(jié)的影響因素

成功的情緒調(diào)節(jié)是各種因素共同作用的結(jié)果,充分認(rèn)識(shí)影響情緒調(diào)節(jié)的潛在因素,有助于幫助精神分裂癥患者改善其情緒調(diào)節(jié)的效果?？傮w來說,潛在的影響精神分裂癥患者情緒調(diào)節(jié)的可能因素主要有以下幾種。

4.1 情緒意識(shí)

情緒意識(shí)是指?jìng)€(gè)體能夠準(zhǔn)確地識(shí)別自身當(dāng)前的情緒狀態(tài),并具備將不同類別的情緒區(qū)分開來的能力(Kimhy et al.,2012)。Gross(2013)指出, 準(zhǔn)確地認(rèn)識(shí)個(gè)體當(dāng)前的(或者是預(yù)期的)情緒狀態(tài),是成功的情緒調(diào)節(jié)的前提,如果此階段個(gè)體不能進(jìn)行有效的情緒識(shí)別,那么隨后的情緒調(diào)節(jié)將面臨著失敗的可能。Kimhy等人(2012)發(fā)現(xiàn),精神分裂癥患者的情緒意識(shí)顯著低于健康人群,這使得他們的社會(huì)功能也顯著弱于健康個(gè)體。此外,該類患者使用表達(dá)抑制策略的頻率和其情緒意識(shí)的貧乏程度之間存在顯著正相關(guān),即情緒意識(shí)越低的精神分裂癥患者,越傾向于使用表達(dá)抑制策略(van der Meer et al.,2009)。結(jié)合前文所述可知,如果在不宜使用表達(dá)抑制策略的條件下,仍然堅(jiān)持使用該策略,將對(duì)個(gè)體的認(rèn)知、情感、社會(huì)功能帶來更多的負(fù)面影響,此時(shí),精神分裂癥患者將難以實(shí)現(xiàn)其最初的情緒調(diào)節(jié)目標(biāo)。

4.2 情緒調(diào)節(jié)目標(biāo)的激活

情緒調(diào)節(jié)目標(biāo)為個(gè)體進(jìn)行情緒調(diào)節(jié)指明了方向,增強(qiáng)(減弱)情緒體驗(yàn)、情緒表達(dá)、生理反應(yīng)的幅度或強(qiáng)度都可以達(dá)成情緒調(diào)節(jié)的目標(biāo)(Gross&Jazaieri,2014;Perry et al.,2012)。此階段需要明確區(qū)分目標(biāo)與非目標(biāo),以便減少非目標(biāo)因素對(duì)目標(biāo)因素的干擾(Gross,2013)。同時(shí),Altamirano,Miyake和Whitmer(2010)指出,當(dāng)個(gè)體需要維持對(duì)單一性目標(biāo)的注意時(shí),使用沉思策略比使用分心策略效果更好,因而明確情緒調(diào)節(jié)目標(biāo)數(shù)量的多少也有助于改善情緒調(diào)節(jié)的效果。此外,Sheppes等人(2014)研究發(fā)現(xiàn),區(qū)分短期目標(biāo)和長(zhǎng)期目標(biāo)能夠幫助個(gè)體更好地進(jìn)行情緒調(diào)節(jié)策略的選擇,持享樂主義調(diào)節(jié)目標(biāo)(Hedonic regulatory goals)的個(gè)體注重的是減少自身當(dāng)前的負(fù)性情緒體驗(yàn),而工具性調(diào)節(jié)目標(biāo)(Instrumental regulatory goals)強(qiáng)調(diào)的則是為更好地實(shí)現(xiàn)其長(zhǎng)期目標(biāo)而選擇適當(dāng)?shù)那榫w調(diào)節(jié)策略。由此可見,有必要幫助精神分裂癥患者樹立明確的情緒調(diào)節(jié)目標(biāo),在此基礎(chǔ)上,該類患者才有可能更有效地靈活選擇和運(yùn)用各種情緒調(diào)節(jié)策略,進(jìn)而達(dá)到理想的情緒調(diào)節(jié)效果。

4.3 文化差異

大量研究表明(Butler,Lee,&Gross,2007,2009;Cutuli,2014;Gross,2013;Soto,Perez,Kim,Lee,&Minnick,2011),表達(dá)抑制策略對(duì)不同文化個(gè)體的影響是不一樣的：表達(dá)抑制策略對(duì)持歐洲文化價(jià)值觀個(gè)體的心理功能具有負(fù)面影響,卻有助于持亞洲文化價(jià)值觀的個(gè)體降低負(fù)性情緒體驗(yàn)、改善社會(huì)功能。具體表現(xiàn)為,相比后者,信奉歐洲文化價(jià)值觀的個(gè)體使用表達(dá)抑制策略時(shí),其心血管系統(tǒng)交感神經(jīng)激活更強(qiáng),血壓更高,更不容易建立親密關(guān)系,受歡迎程度、主觀幸福感更低,獲得的社會(huì)支持更少。Perez和Soto(2011)以波多黎各人和拉丁裔美國人(均為在校大學(xué)生)為被試,考察了不同壓迫條件下,上述兩個(gè)種族大學(xué)生使用認(rèn)知重評(píng)策略及其身心健康之間的關(guān)系。問卷測(cè)驗(yàn)結(jié)果表明,波多黎各人只感受到來自外族的壓迫,不會(huì)體驗(yàn)到來自本族群內(nèi)部的壓迫,而拉美人則同時(shí)感受到來自族群內(nèi)和族群外的壓迫。調(diào)查結(jié)果顯示,不論民族壓迫意識(shí)高低,波多黎各人使用認(rèn)知重評(píng)策略頻率的高低始終與其心理機(jī)能水平成正相關(guān),對(duì)于民族壓迫意識(shí)體驗(yàn)強(qiáng)烈的拉丁裔美國人而言,使用認(rèn)知重評(píng)策略的頻率與其心理機(jī)能水平成負(fù)相關(guān)。該研究揭示了個(gè)體所處的不同壓迫情境對(duì)同一情緒調(diào)節(jié)策略與其心理機(jī)能之間的不同聯(lián)系。綜述之,在開展情緒調(diào)節(jié)方面的研究工作時(shí),應(yīng)該立足本土實(shí)際,結(jié)合本國文化的特殊性,辨證的看待已有的外國研究成果,為促進(jìn)該領(lǐng)域在國內(nèi)更好的發(fā)展,提供有利借鑒。

4.4 生理機(jī)能

Green,Waldron,Simpson和Coltheart(2008)選取健康人群和精神分裂癥患者作為被試,進(jìn)行了一項(xiàng)眼動(dòng)實(shí)驗(yàn),實(shí)驗(yàn)刺激材料為7組彩色圖片(每組2張圖片,共14張),相應(yīng)的每組圖片中都會(huì)出現(xiàn)一張相同的面孔表情圖片,兩張圖片的差別為,其中一張面孔圖片不呈現(xiàn)任何背景信息(非情境性面孔圖片),另一張圖片會(huì)呈現(xiàn)與面孔表情包含的情緒效價(jià)一致的社會(huì)情境(情境性面孔圖片),被試的任務(wù)是口頭報(bào)告每張圖片中人物的情緒狀態(tài)。實(shí)驗(yàn)結(jié)果表明,健康個(gè)體注視情境性面孔圖片的時(shí)間顯著短于注視非情境性面孔圖片,而精神分裂癥患者注視情境性面孔圖片的時(shí)間顯著長(zhǎng)于注視非情境性面孔圖片,表明該類患者存在信息整合能力方面的缺陷,而這種缺陷會(huì)影響他們通過面部表情來推測(cè)他人情緒狀態(tài)的能力。Wynn,Jahshan,Altshuler,Glahn 和 Green(2013)的ERP研究揭示了精神分裂癥患者生理機(jī)能上的異常,該研究顯示,精神分裂癥患者識(shí)別高興、憤怒、恐懼、羞愧、悲傷、驚訝等情緒性圖片誘發(fā)的N170波幅顯著低于健康人群,而N170通常被視為面孔加工特異性成分(Batty&Taylor,2003;Luo,Feng,He,Wang,&Luo,2010),其波幅大小對(duì)早期面部結(jié)構(gòu)特征加工十分敏感(Batty&Taylor,2003;Holmes,Vuilleumier,&Eimer,2003;Pizzagalli,Regard,&Lehmann,1999;Righart&de Gelder,2006),這就表明精神分裂癥患者的面部結(jié)構(gòu)編碼能力出現(xiàn)了異常。此外,一項(xiàng)fMRI研究(van der Meer et al.,2014)表明,精神分裂癥患者重評(píng)負(fù)性圖片引起的腦島、腹外側(cè)前額葉皮層、顳中回、尾狀核以及丘腦的激活顯著弱于健康人群,而前腦島與情緒加工及情緒意識(shí)有關(guān)(Craig,2009)。

還有fMRI研究(Mier et al.,2014;Taylor et al.,2012;Taylor&MacDonald,2012)發(fā)現(xiàn),健康人群在觀看恐懼、憤怒、高興等情緒性面孔表情時(shí),其杏仁核激活水平顯著高于觀看中性面孔表情。然而,另一些研究(Anticevic et al.,2012;Gradin et al.,2011;Green,Horan,&Lee,2015)表明,情緒性刺激引起的精神分裂癥患者的杏仁核激活水平低于健康人群。此外,還有研究(Kring&Elis,2013;Mier et al.,2014)表明,在完成內(nèi)隱情緒識(shí)別任務(wù)時(shí),精神分裂癥患者的杏仁核激活水平低于控制組,而完成外顯任務(wù)時(shí),上述差異消失。以上研究共同表明精神分裂癥患者的杏仁核功能出現(xiàn)了異常,這種異常是由多種原因?qū)е碌?。首?精神分裂癥患者的杏仁核與其他腦區(qū)之間的功能連接出現(xiàn)了異常。例如,該類患者杏仁核與梭狀回之間的連接比控制組弱(Hall et al.,2008),杏仁核–眶額皮層的耦合程度低于控制組(Anticevic et al.,2014),他們完成社會(huì)決策任務(wù)時(shí),杏仁核–腦島之間的連接弱于控制組(Mukherjee et al.,2014)。此外,健康個(gè)體的前額皮層激活水平與其杏仁核激活水平成反比,但精神分裂癥患者完成相同任務(wù)時(shí),卻沒有出現(xiàn)上述反比關(guān)系,這表明精神分裂癥患者的前額皮層和杏仁核之間的連接可能出現(xiàn)了異常(Green et al.,2015)。其次,這可能與男性精神分裂癥患者的杏仁核體積比健康人群小有關(guān)(Gur et al.,2004)。第三,這種異常還與患者的陰性癥狀嚴(yán)重程度(Yan et al.,2015;Pinkham,Gur,&Gur,2007;Surguladze et al.,2006;Taylor,Liberzon,Decker,&Koeppe,2002)、不同精神分裂癥亞類型,如是否為躁狂型(Williams et al.,2007;Pinkham et al.,2015)或攻擊性(易嘉龍等,2009)患者有關(guān)。鑒于杏仁核對(duì)個(gè)體情緒調(diào)節(jié)具有重要作用(Cutuli,2014),我們認(rèn)為精神分裂癥患者杏仁核功能紊亂是導(dǎo)致其情緒調(diào)節(jié)出現(xiàn)異常的重要原因。

5 總結(jié)與研究展望

情緒調(diào)節(jié)已成為一個(gè)發(fā)展成熟的研究領(lǐng)域。關(guān)于情緒調(diào)節(jié)的早期研究,可以追溯到100多年以前,那時(shí)情緒調(diào)節(jié)處于興起階段,早期的精神分析理論中關(guān)于防御理論的闡述可以視作是這一時(shí)期的代表。20世紀(jì)五六十年代到90年代以前這一段時(shí)間可以看作是情緒調(diào)節(jié)發(fā)展的第二個(gè)階段,此階段的典型代表是Lazarus和Alfert(1964)開展的以評(píng)估防御性操作有效性為主題的一系列研究。雖然這兩個(gè)階段有關(guān)情緒調(diào)節(jié)的研究發(fā)展始終沒有中斷,但是發(fā)展速度是極其緩慢的,檢索谷歌學(xué)術(shù)發(fā)現(xiàn),這兩個(gè)階段只有相對(duì)較少的關(guān)于情緒調(diào)節(jié)的論文發(fā)表。20世紀(jì)90年代至今的這一段時(shí)期可以視作是情緒調(diào)節(jié)發(fā)展的第三階段,此時(shí)情緒調(diào)節(jié)已成為心理學(xué)中發(fā)展最快的領(lǐng)域之一(Koole,2009),這一點(diǎn)在論文發(fā)表數(shù)量上可以得到印證,此階段該領(lǐng)域的論文發(fā)表數(shù)量已逐年呈指數(shù)級(jí)增長(zhǎng)。這一時(shí)期具有標(biāo)志性的事件是Gross(1998a,1998b)提出了情緒調(diào)節(jié)加工模型。值得注意的是,雖然情緒調(diào)節(jié)有著一個(gè)漫長(zhǎng)的發(fā)展過程,但是以往研究主要是圍繞著健康人群展開的,以精神分裂癥患者為對(duì)象的情緒調(diào)節(jié)方面的研究則是近10年內(nèi)才在歐美國家興起的,而且研究技術(shù)手段相對(duì)較單一,主要集中于行為實(shí)驗(yàn),少有這方面的事件相關(guān)電位(ERP)研究,至于這方面的功能性磁共振成像(fMRI)則更少(van der Meer et al.,2014)。尤其需要指出的是,精神分裂癥患者作為一種特殊群體,雖然他們的情緒狀態(tài)直接關(guān)系到其心理健康水平、認(rèn)知功能、社會(huì)功能的發(fā)展與完善,但是通過檢索中國知網(wǎng)、維普、萬方等數(shù)據(jù)庫發(fā)現(xiàn),截至2015年7月,國內(nèi)尚沒有專門針對(duì)精神分裂癥患者情緒調(diào)節(jié)這一主題展開的研究,本文是首篇論述精神分裂癥患者情緒調(diào)節(jié)的中文論文。綜述之,情緒調(diào)節(jié)是一個(gè)發(fā)展成熟的心理學(xué)分支,但有關(guān)精神分裂癥患者情緒調(diào)節(jié)的研究仍然處于起步階段。

本文結(jié)合Gross的情緒調(diào)節(jié)加工模型,從對(duì)精神分裂癥患者進(jìn)行情緒調(diào)節(jié)的必要性、不同情緒調(diào)節(jié)策略的特點(diǎn)及其對(duì)個(gè)體的影響、精神分裂癥患者情緒調(diào)節(jié)的影響因素等方面進(jìn)行了系統(tǒng)的回顧和總結(jié),總體來說,精神患者的情緒體驗(yàn)和情緒調(diào)節(jié)都存在異常,而且針對(duì)該類患者進(jìn)行情緒調(diào)節(jié)干預(yù)和治療、訓(xùn)練是可行的,未來研究可以考慮從以下方面著手。

首先,從精神分裂癥患者的角度而言,第一,由于情緒意識(shí)的缺乏,是導(dǎo)致精神分裂癥患者習(xí)慣于采用非適應(yīng)性情緒調(diào)節(jié)策略的一個(gè)重要因素(O'Driscoll et al.,2014),結(jié)合前文提到的情緒調(diào)節(jié)的核心特征,在未來研究中,可以嘗試從增強(qiáng)該類患者的情緒意識(shí)著手。準(zhǔn)確的識(shí)別與描述自身當(dāng)前的情緒狀態(tài)的能力是完整的情緒意識(shí)的重要組成部分,而這種能力正是精神分裂癥患者所缺乏的(Kimhy et al.,2012),鑒于其有效性(Huddy,Reeder,Kontis,Wykes,&Stahl,2012;Keshavan,Vinogradov,Rumsey,Sherrill,&Wagner,2014;Kontis,Huddy,Reeder,Landau,&Wykes,2013),可嘗試結(jié)合認(rèn)知行為療法、情感關(guān)注療法等方法來提高該類患者的情緒識(shí)別與描述自我效能感,進(jìn)而增強(qiáng)其情緒意識(shí)。第二,Gyurak等(2011)發(fā)現(xiàn),針對(duì)廣泛性焦慮障礙患者而言,該類個(gè)體明顯的內(nèi)隱情緒調(diào)節(jié)缺陷與其癥狀的嚴(yán)重程度之間是存在顯著相關(guān)的,但就精神分裂癥患者而言,目前少有研究探討陰性癥狀嚴(yán)重程度對(duì)該類患者情緒調(diào)節(jié)的影響。例如,有研究發(fā)現(xiàn),精神分裂癥患者的陰性癥狀嚴(yán)重程度與其調(diào)節(jié)悲傷情緒的能力成負(fù)相關(guān),即精神分裂癥患者在發(fā)病期(陰性癥狀較嚴(yán)重)調(diào)節(jié)悲傷情緒更困難,在治愈后(只有輕微程度的陰性癥狀)調(diào)節(jié)悲傷情緒更容易(Daros et al.,2014)。這種負(fù)相關(guān)關(guān)系是否是穩(wěn)定存在的,還有待于進(jìn)一步驗(yàn)證,以便針對(duì)不同發(fā)病期的患者制定有針對(duì)性的治療方案。第三,情緒調(diào)節(jié)是一個(gè)動(dòng)態(tài)的變化過程,成功的情緒調(diào)節(jié)不應(yīng)僅僅滿足于能改變個(gè)體當(dāng)前的情緒狀態(tài),而且也應(yīng)考慮到調(diào)節(jié)后效,應(yīng)該能夠在較長(zhǎng)時(shí)間內(nèi)幫助個(gè)體維持良好的情緒狀態(tài)。但是,當(dāng)前研究主要集中于考察不同情緒調(diào)節(jié)策略對(duì)精神分裂癥患者的實(shí)時(shí)影響,尚沒有揭示不同策略對(duì)精神分裂癥患者的長(zhǎng)期影響,因而可以圍繞不同策略對(duì)精神分裂癥患者情緒調(diào)節(jié)效果的影響的時(shí)效性展開研究。

其次,就研究精神分裂癥患者情緒調(diào)節(jié)策略的技術(shù)(方法、手段)而言,當(dāng)前研究主要是采用問卷測(cè)量法、自我口頭報(bào)告法、行為實(shí)驗(yàn)法來研究精神分裂癥患者情緒調(diào)節(jié)的特點(diǎn),而該類個(gè)體通常存在情緒意識(shí)、情緒表達(dá)(Kimhy et al.,2012;Trémeau,2006)方面的缺陷,難以保證他們能夠準(zhǔn)確地描述其情緒狀態(tài),而且以上方法存在較大程度上的主觀性,不能客觀有效地反應(yīng)實(shí)際研究結(jié)果。當(dāng)前關(guān)于精神分裂癥患者情緒調(diào)節(jié)的fMRI研究十分稀少,Ruiz等人(2013)首次發(fā)現(xiàn),精神分裂癥患者通過實(shí)時(shí)fMRI反饋訓(xùn)練來學(xué)習(xí)有意識(shí)地情緒調(diào)節(jié),有助于改善該類患者的情緒感知能力,同時(shí)也可以調(diào)整其腦網(wǎng)絡(luò)鏈接,凸顯了fMRI技術(shù)在個(gè)體情緒調(diào)節(jié)中所起的重要作用。Nolen-Hoeksema(2012)則首次發(fā)現(xiàn)不同性別的精神分裂癥患者存在情緒識(shí)別與情緒調(diào)節(jié)方面的差異,例如,女性患者比男性患者更多的使用沉思策略,但他卻沒有交代導(dǎo)致這種差異的腦機(jī)制。在未來研究中,可充分利用ERP高時(shí)間分辨率和fMRI高空間分辨力的優(yōu)勢(shì),從生理成因?qū)用孢M(jìn)一步探討出現(xiàn)上述差異的原因,以及這些差異是如何影響精神分裂癥患者的情緒調(diào)節(jié)的,從而可以更有效地揭示精神分裂癥患者情緒調(diào)節(jié)潛在的客觀生理機(jī)制。此外,應(yīng)該注意加強(qiáng)不同學(xué)科之間的合作,充分整合心理學(xué)、精神病理學(xué)、生物學(xué)等多學(xué)科知識(shí),以便促進(jìn)該類個(gè)體更有效地進(jìn)行情緒調(diào)節(jié),進(jìn)而助其改善心理健康狀況。

第三,已有的關(guān)于Gross的情緒調(diào)節(jié)加工模型(包括情境選擇、情境修正、注意分配、認(rèn)知改變和反應(yīng)調(diào)整5個(gè)部分)在精神分裂癥患者情緒調(diào)節(jié)過程中所起的作用的研究,主要集中于探討后兩個(gè)部分的作用,在后期研究中,可以進(jìn)一步探討精神分裂癥患者在情緒調(diào)節(jié)過程中,是否運(yùn)用了前3種策略,以及它們分別會(huì)給精神分裂癥個(gè)體帶來怎樣的影響。此外,本文凸顯了Gross的情緒調(diào)節(jié)加工模型在精神分裂癥患者情緒治療過程中所起的重要作用,但這并不意味著只有該模型才能指導(dǎo)精神分裂癥患者進(jìn)行情緒治療,其他情緒調(diào)節(jié)模型在精神分裂癥患者情緒調(diào)節(jié)過程中所起的作用同樣不可忽略。鑒于綜合運(yùn)用多種情緒調(diào)節(jié)策略有助于精神分裂癥患者進(jìn)行有效地情緒調(diào)節(jié)(Khoury,Lecomte,Comtois,&Nicole,2015),因而在臨床治療中,也應(yīng)讓精神分裂癥患者注意到其它模型對(duì)情緒治療的指導(dǎo)意義,并逐步培養(yǎng)他們運(yùn)用這些模型的能力,只有熟練掌握、靈活運(yùn)用各種情緒調(diào)節(jié)策略,才能更好地幫助精神分裂癥患者提高其情緒調(diào)節(jié)能力,從而幫助他們建立健全的社會(huì)功能。

程利,袁加錦,何媛媛,李紅.(2009).情緒調(diào)節(jié)策略:認(rèn)知重評(píng)優(yōu)于表達(dá)抑制.心理科學(xué)進(jìn)展,17,730–745.

孟昭蘭.(主編).(2005).情緒心理學(xué).北京:北京大學(xué)出版社.

邢采,楊苗苗.(2013).通過注意訓(xùn)練調(diào)節(jié)情緒:方法及證據(jù).心理科學(xué)進(jìn)展,21,1780–1793.

易嘉龍,王小平,廖堅(jiān),王維,王坤,蔣田仔.(2009).男性攻擊性精神分裂癥患者杏仁核功能連接的磁共振研究.中國臨床心理學(xué)雜志,17,669–671.

張晶,周仁來,李永娜,韋慶旺,胡平,劉珂.(2014).自動(dòng)情緒調(diào)節(jié)的神經(jīng)機(jī)制及其可塑性.心理科學(xué)進(jìn)展,22,9–13.

Aldao,A.,&Dixon-Gordon,K.L.(2014).Broadening the scope of research on emotion regulation strategies and psychopathology.Cognitive Behaviour Therapy,43(1),22–33.

Aldao,A.,Jazaieri,H.,Goldin,P.R.,&Gross,J.J.(2014).Adaptive and maladaptive emotion regulation strategies:Interactive effects during CBT for social anxiety disorder.Journal of Anxiety Disorders,28(4),382–389.

Aldao,A.,&Nolen-Hoeksema,S.(2012).When are adaptive strategies most predictive of psychopathology?Journal of Abnormal Psychology,121(1),276–281.

Aldao,A.,Nolen-Hoeksema,S.,&Schweizer,S.(2010).Emotion-regulation strategies across psychopathology:A meta-analytic review.Clinical Psychology Review,30(2),217–237.

Altamirano,L.J.,Miyake,A.,&Whitmer,A.J.(2010).When mental inflexibility facilitates executive control:Beneficial side effects of ruminative tendencies on goal maintenance.Psychological Science,21,1377–1382.

Anticevic,A.,Tang,Y.Q.,Cho,Y.T.,Repovs,G.,Cole,M.W.,Savic,A.,…Xu,K.(2014).Amygdala connectivity differs among chronic,early course,and individuals at risk for developing schizophrenia.Schizophrenia Bulletin,40(5),1105–1116.

Anticevic,A.,van Snellenberg,J.X.,Cohen,R.E.,Repovs,G.,Dowd,E.C.,&Barch,D.M.(2012).Amygdala recruitmentin schizophrenia in response to aversive emotionalmaterial:A meta-analysisofneuroimaging studies.Schizophrenia Bulletin,38(3),608–621.

Badcock,J.C.,Paulik,G.,&Maybery,M.T.(2011).The role of emotion regulation in auditory hallucinations.Psychiatry Research,185(3),303–308.

Barch,D.M.,& Ceaser,A.(2012).Cognition in schizophrenia:Core psychological and neural mechanisms.Trends in Cognitive Sciences,16(1),27–34.

Batty,M.,&Taylor,M.J.(2003).Early processing of the six basic facialemotionalexpressions.Cognitive Brain Research,17(3),613–620.

Berenbaum,H.,Raghavan,C.,Le,H.N.,Vernon,L.L.,&Gomez, J. J. (2003). A taxonomy of emotional disturbances.Clinical Psychology:Science and Practice,10(2),206–226.

Boden,M.T.,John,O.P.,Goldin,P.R.,Werner,K.,Heimberg,R.G.,&Gross,J.J.(2012).The role of maladaptive beliefs in cognitive-behavioral therapy:Evidence from social anxiety disorder.Behaviour Research and Therapy,50(5),287–291.

Boden,M.T.,Westermann,S.,McRae,K.,Kuo,J.,Alvarez,J.,Kulkarni,M.R.,… Bonn-Miller,M.O.(2013).Emotion regulation and posttraumatic stress disorder:A prospective investigation.Journal of Social and Clinical Psychology,32(3),296–314.

Brekke,J.S.,Hoe,M.,& Green,M.F.(2009).Neurocognitive change,functional change and service intensity during community-based psychosocial rehabilitation for schizophrenia.Psychological Medicine,39(10),1637–1647.

Bridges,L.J.,Denham,S.A.,&Ganiban,J.M.(2004).Definitional issues in emotion regulation research.Child Development,75(2),340–345.

Brummer,L.,Stopa,L.,&Bucks,R.(2014).The influence of age on emotion regulation strategies and psychological distress.Behavioural and Cognitive Psychotherapy,42(6),668–681.

Burrus,C.(2013).Developmental trajectories of abuse–An hypothesis for the effects of early childhood maltreatment on dorsolateral prefrontal cortical development.Medical Hypotheses,81(5),826–829.

Butler,E.A.,Lee,T.L.,&Gross,J.J.(2007).Emotion regulation and culture:Are the social consequences of emotion suppression culture-specific?Emotion, 7(1),30–48.

Butler,E.A.,Lee,T.L.,&Gross,J.J.(2009).Does expressing your emotions raise or loweryour blood pressure?The answer depends on cultural context.Journal of Cross-Cultural Psychology,40(3),510–517.

Campbell-Sills,L.,Barlow,D.H.,Brown,T.A.,&Hofmann,S.G.(2006).Effects of suppression and acceptance on emotional responses of individuals with anxiety and mood disorders.Behaviour Research and Therapy,44(9),1251–1263.

Chambers,R.,Gullone,E.,&Allen,N.B.(2009).Mindful emotion regulation: An integrative review.Clinical Psychology Review,29(6),560–572.

Cole,P.M.,Martin,S.E.,&Dennis,T.A.(2004).Emotion regulation as a scientific construct:Methodological challenges and directions for child development research.Child Development,75(2),317–333.

Craig,A.D.(2009).How do you feel-now?The anterior insula and human awareness.Nature Reviews Neuroscience,10(1),59–70.

Cutuli,D.(2014).Cognitive reappraisal and expressive suppression strategies role in the emotion regulation:An overview on their modulatory effects and neural correlates.Frontiers in Systems Neuroscience,8,175.

Daros,A.R.,Ruocco,A.C.,Reilly,J.L,Harris,M.S.,&Sweeney,J.A.(2014).Facial emotion recognition in first-episode schizophrenia and bipolardisorderwith psychosis.Schizophrenia Research,153(1-3),32–37.

de Achával,D.,Villarreal,M.F.,Salles,A.,Bertomeu,M.J.,Costanzo,E.Y.,Goldschmidt,M.,…Guinjoan,S.M.(2013).Activation of brain areas concerned with social cognition during moral decisions is abnormal in schizophrenia patients and unaffected siblings.Journal of Psychiatric Research,47(6),774–782.

Drabant,E.M.,McRae,K.,Manuck,S.B.,Hariri,A.R.,&Gross,J.J.(2009).Individualdifferences in typical reappraisal use predict amygdala and prefrontal responses.Biological Psychiatry,65(5),367–373.

Egloff,B.,Schmukle,S.C.,Burns,L.R.,&Schwerdtfeger,A. (2006). Spontaneous emotion regulation during evaluated speaking tasks:Associations with negative affect,anxiety expression,memory,and physiological responding.Emotion,6(3),356–366.

Ehring,T.,Tuschen-Caffier,B.,Schnülle,J.,Fischer,S.,&Gross,J.J.(2010).Emotion regulation and vulnerability to depression:Spontaneous versus instructed use of emotion suppression and reappraisal.Emotion,10(4),563–572.

Erol,A.,Putgul,G.,Kosger,F.,&Ersoy,B.(2013).Facial emotion recognition in schizophrenia:Theimpactof gender.Psychiatry Investigation,10(1),69–74.

Exner,C.,Boucsein,K.,Degner,D.,Irle,E.,&Weniger,G.(2004). Impaired emotional learning and reduced amygdala size in schizophrenia:A 3-month follow-up.Schizophrenia Research,71(2-3),493–503.

Fan,F.-M.,Tan,S.-P.,Yang,F.-D.,Tan,Y.-L.,Zhao,Y.-L.,Chen,N.,…Zou,X.N.(2013).Ventral medial prefrontal functional connectivity and emotion regulation in chronic schizophrenia:A pilot study.Neuroscience Bulletin,29(1),59–74.

Fett,A.-K.J.,Viechtbauer,W.,Dominguez,M.-d.-G.,Penn,D.L.,vanOs,J.,& Krabbendam,L.(2011).The relationship between neurocognition and social cognition with functional outcomes in schizophrenia:A meta-analysis.Neuroscience&Biobehavioral Reviews,35(3),573–588.

Fletcher,K.,Parker,G.,Bayes,A.,Paterson,A.,&McClure,G.(2014).Emotion regulation strategies in bipolar II disorder and borderline personality disorder:Differences and relationships with perceived parental style.Journal of Affective Disorders,157,52–59.

Giuliani,N.R.,Drabant,E.M.,Bhatnagar,R.,&Gross,J.J.(2011).Emotion regulation and brain plasticity:Expressive suppression use predicts anterior insula volume.Neuroimage,58(1),10–15.

Goldin,P.R.,Jazaieri,H.,Ziv,M.,Kraemer,H.,Heimberg,R.G.,& Gross,J.J.(2013).Changesin positive self-views mediate the effectofcognitive-behavioral therapy for social anxiety disorder.Clinical Psychological Science,1(3),301–310.

Gradin,V.B.,Kumar,P.,Waiter,G.,Ahearn,T.,Stickle,C.,Milders,M.,…Steele,J.D.(2011).Expected value and prediction error abnormalities in depression and schizophrenia.Brain,134(6),1751–1764.

Green,M.F.(2007).Stimulating the development of drug treatments to improve cognition in schizophrenia.Annual Review of Clinical Psychology,3,159–180.

Green,M.F.,Horan,W.P.,& Lee,J.(2015).Social cognition in schizophrenia.Nature Reviews Neuroscience,16(10),620–631.

Green,M.F.,&Leitman,D.I.(2008).Social cognition in schizophrenia.Schizophrenia Bulletin,34(4),670–672.

Green,M.J.,Waldron,J.H.,Simpson,I.,&Coltheart,M.(2008).Visual processing of social context during mental state perception in schizophrenia.Journal of Psychiatry&Neuroscience,33(1),34–42.

Gresham,D.,&Gullone,E.(2012).Emotion regulation strategy use in children and adolescents:The explanatory rolesofpersonality and attachment.Personality and Individual Differences,52(5),616–621.

Grezellschak,S.,Lincoln,T.M.,&Westermann,S.(2015).Cognitive emotion regulation in patients with schizophrenia:Evidence for effective reappraisal and distraction.Psychiatry Research,229(1-2),434–439.

Gross,J.J.(1998a).Antecedent-and response-focused emotion regulation:Divergent consequences for experience,expression,and physiology.Journal of Personality and Social Psychology,74(1),224–237.

Gross,J.J.(1998b).The emerging field ofemotion regulation:An integrative review.Review of General Psychology,2(3),271–299.

Gross,J.J.(2002).Emotion regulation:Affective,cognitive,and social consequences.Psychophysiology,39(3),281–291.

Gross,J.J.(2013).Emotion regulation:Taking stock and moving forward.Emotion,13(3),359–365.

Gross,J.J.,&Barrett,L.F.(2011).Emotion generation and emotion regulation:One or two depends on your point of view.Emotion Review,3(1),8–16.

Gross,J.J.,& Jazaieri,H.(2014).Emotion,emotion regulation,and psychopathology:An affective science perspective.Clinical Psychological Science,2(4),387–401.

Gross,J.J.,&John,O.P.(2003).Individual differences in two emotion regulation processes:Implications for affect,relationships,and well-being.Journal of Personality and Social Psychology,85(2),348–362.

Gross,J.J.,&Levenson,R.W.(1993).Emotional suppression:Physiology,self-report,and expressive behavior.Journal of Personality and Social Psychology,64(6),970–986.

Gross,J.J.,Sheppes,G.,&Urry,H.L.(2011).Cognition and emotion lecture at the 2010 SPSP emotion preconference: Emotion generation and emotion regulation:A distinction we should make(carefully).Cognition and Emotion,25(5),765–781.

Gruber,J.,Harvey,A.G.,&Gross,J.J.(2012).When trying is not enough:Emotion regulation and the effort–success gap in bipolar disorder.Emotion,12(5),997–1003.

Gruber,J.,Hay,A.C.,&Gross,J.J.(2014).Rethinking emotion:Cognitive reappraisal is an effective positive and negative emotion regulation strategy in bipolar disorder.Emotion,14(2),388–396.

Gur,R.E.,Kohler,C.,Turetsky,B.I.,Siegel,S.J.,Kanes,S.J.,Bilker,W.B.,… Gur,R.C.(2004).A sexually dimorphic ratio of orbitofrontal to amygdala volume is altered in schizophrenia.Biological Psychiatry,55(5),512–517.

Gyurak,A.,Gross,J.J.,&Etkin,A.(2011).Explicit and implicit emotion regulation:A dual-process framework.Cognition and Emotion,25(3),400–412.

Hall,J.,Whalley,H.C.,McKirdy,J.W.,Romaniuk,L.,McGonigle,D.,McIntosh,A.M.,…Lawrie,S.M.(2008).Overactivation of fear systems to neutral faces in schizophrenia.Biological Psychiatry,64,70–73.

Hallam,G.P.,Webb,T.L.,Sheeran,P.,Miles,E.,Niven,K.,Wilkinson,I.D.,…Farrow,T.F.(2014).The neural correlates of regulating another person's emotions:An exploratory fMRI study.Frontiers in Human Neuroscience,8,376.

Henry,J.D.,Rendell,P.G.,Green,M.J.,McDonald,S.,&O'Donnell,M.(2008).Emotion regulation in schizophrenia:Affective,social,and clinical correlates of suppression and reappraisal.Journal of Abnormal Psychology,117(2),473–478.

Hofmann,S.G.,Moscovitch,D.A.,Litz,B.T.,Kim,H.-J.,Davis,L.L.,&Pizzagalli,D.A.(2005).The worried mind:Autonomic and prefrontal activation during worrying.Emotion,5(4),464–475.

Hofmann,W.,Friese,M.,&Roefs,A.(2009).Three ways to resist temptation:The independent contributions of executive attention,inhibitory control,and affect regulation to the impulse control of eating behavior.Journal of Experimental Social Psychology,45(2),431–435.

Holmes,A.,Vuilleumier,P.,& Eimer,M.(2003).The processing of emotional facial expression is gated by spatial attention:Evidence from event-related brain potentials.Cognitive Brain Research,16(2),174–184.

Hooker,C.I.,Benson,T.L.,Gyurak,A.,Yin,H.,Tully,L.M.,&Lincoln,S.H.(2014).Neural activity to positive expressions predicts daily experience of schizophreniaspectrum symptoms in adults with high social anhedonia.Journal of Abnormal Psychology,123(1),190–204.

Horan,W.P.,Hajcak,G.,Wynn,J.K.,&Green,M.F.(2013).Impaired emotion regulation in schizophrenia:Evidence from event-related potentials.Psychological Medicine,43(11),2377–2391.

Hu,T.Q.,Zhang,D.J.,Wang,J.L.,Mistry,R.,Ran,G.M.,& Wang,X.Q.(2014).Relation between emotion regulation and mental health:A meta-analysis review.Psychological Reports,114(2),341–362.

Huddy,V.,Reeder,C.,Kontis,D.,Wykes,T.,&Stahl,D.(2012).The effect of working alliance on adherence and outcome in cognitive remediation therapy.The Journal of Nervous and Mental Disease,200(7),614–619.

Jackson,D.C.,Mueller,C.J.,Dolski,I.,Dalton,K.M.,Nitschke,J.B.,Urry,H.L.,…Davidson,R.J.(2003).Now you feel it,now you don't:Frontal brain electrical asymmetry and individual differences in emotion regulation.Psychological Science,14(6),612–617.

Jahshan,C.,Wynn,J.K.,McCleery,A.,Glahn,D.C.,Altshuler,L.L.,&Green,M.F.(2014).Cross-diagnostic comparison of visual processing in bipolar disorder and schizophrenia.Journal of Psychiatric Research,51,42–48.

Jazaieri,H.,Urry,H.L.,&Gross,J.J.(2013).Affective disturbance and psychopathology:An emotion regulation perspective.Journal of Experimental Psychopathology,4(5),584–599.

John,O.P.,&Gross,J.J.(2004).Healthy and unhealthy emotion regulation: Personality processes,individual differences,and life span development.Journal of Personality,72(6),1301–1334.

Keshavan,M.S.,Vinogradov,S.,Rumsey,J.,Sherrill,J.,&Wagner,A.(2014).Cognitive training in mental disorders:Update and future directions.American Journalof Psychiatry,171(5),510–522.

Khoury,B.,Lecomte,T.,Comtois,G.,&Nicole,L.(2015).Third-wave strategies for emotion regulation in early psychosis:A pilot study.Early Intervention in Psychiatry,9(1),76–83.

Kimhy,D.,Vakhrusheva,J.,Jobson-Ahmed,L.,Tarrier,N.,Malaspina,D.,&Gross,J.J.(2012).Emotion awareness and regulation in individuals with schizophrenia:Implications for social functioning.Psychiatry Research,200(2-3),193–201.

Kimhy,D.,Vakhrusheva,J.,Khan,S.,Chang,R.W.,Hansen,M.C.,Ballon,J.S.,…Gross,J.J.(2014).Emotional granularity and social functioning in individuals with schizophrenia:An experience sampling study.Journal of Psychiatric Research,53,141–148.

Kontis,D.,Huddy,V.,Reeder,C.,Landau,S.,&Wykes,T.(2013).Effects of age and cognitive reserve on cognitive remediation therapy outcome in patients with schizophrenia.TheAmerican Journal of Geriatric Psychiatry,21(3),218–230.

Koole,S.L.(2009).The psychology of emotion regulation:An integrative review.Cognition and Emotion,23(1),4–41.

Kring,A.M.,&Elis,O.(2013).Emotion deficits in people with schizophrenia.Annual Review of Clinical Psychology,9,409–433.

Kubzansky,L.D.,Park,N.,Peterson,C.,Vokonas,P.,&Sparrow,D.(2011).Healthy psychological functioning and incident coronary heart disease:The importance of self-regulation.Archives of General Psychiatry,68(4),400–408.

Lar?i,F.,Fonteneau,B.,Mourad,H.,&Raballo,A.(2010).Basic emotion recognition and psychopathology in schizophrenia.The JournalofNervous and Mental Disease,198(1),79–81.

Larsen,R.J.(2000).Toward a science of mood regulation.Psychological Inquiry,11(3),129–141.

Lazarus,R.S.,&Alfert,E.(1964).Short-circuiting of threat by experimentally altering cognitive appraisal.The Journal of Abnormal and Social Psychology,69(2),195–205.

Lederbogen,F.,Kirsch,P.,Haddad,L.,Streit,F.,Tost,H.,Schuch,P.,…Meyer-Lindenberg A,A.(2011).City living and urban upbringing affect neural social stress processing in humans.Nature,474(7352),498–501.

Lee,J.,Altshuler,L.,Glahn,D.C.,Miklowitz,D.J.,Ochsner,K.,&Green,M.F.(2013).Social and nonsocial cognition in bipolar disorder and schizophrenia:Relative levels of impairment.The American Journal of Psychiatry,170(3),334–341.

Lehmann,A.,Bah?esular,K.,Brockmann,E.M.,Biederbick,S.-E.,Dziobek,I.,Gallinat,J.,&Montag,C.(2014).Subjective experience of emotions and emotional empathy in paranoid schizophrenia.Psychiatry Research,220(3),825–833.

Luo,W.B.,Feng,W.F.,He,W.Q.,Wang,N.Y.,&Luo,Y.J.(2010).Three stages of facial expression processing:ERP study with rapid serial visual presentation.Neuroimage,49(2),1857–1867.

Malik,S.,Wells,A.,&Wittkowski,A.(2015).Emotion regulation as a mediator in the relationship between attachment and depressive symptomatology:A systematic review.Journal Of Affective Disorders,172,428–444.

Maren,S.(1999).Long-term potentiation in the amygdala:A mechanism for emotional learning and memory.Trends in Neurosciences,22(12),561–567.

Mauss,I.B.,Bunge,S.A.,&Gross,J.J.(2007).Automatic emotion regulation.Social and Personality Psychology Compass,1(1),146–167.

Mauss,I.B.,Cook,C.L.,Cheng,J.Y.J.,&Gross,J.J.(2007).Individual differences in cognitive reappraisal:Experiential and physiological responsesto an anger provocation.International Journal of Psychophysiology,66(2),116–124.

Mauss,I.B.,Levenson,R.W.,McCarter,L.,Wilhelm,F.H.,&Gross,J.J.(2005).The tie that binds?Coherence among emotion experience,behavior,and physiology.Emotion,5(2),175–190.

McLaughlin,K.A.,Hatzenbuehler,M.L.,Mennin,D.S.,&Nolen-Hoeksema,S.(2011).Emotion dysregulation and adolescent psychopathology:A prospective study.Behaviour Research and Therapy,49(9),544–554.

McRae,K.,Rekshan,W.,Williams,L.M.,Cooper,N.,&Gross,J.J.(2014).Effects of antidepressant medication on emotion regulation in depressed patients:An iSPOT-Dreport.Journal of Affective Disorders,159,127–132.

Mennin,D.,&Farach,F.(2007).Emotion and evolving treatments for adult psychopathology.Clinical Psychology:Science and Practice,14(4),329–352.

Mier,D.,Lis,S.,Zygrodnik,K.,Sauer,C.,Ulferts,J.,Gallhofer,B.,&Kirsch,P.(2014).Evidence for altered amygdala activation in schizophrenia in an adaptive emotion recognition task.Psychiatry Research:Neuroimaging,221(3),195–203.

Mitchell,D.G.V.(2011).The nexus between decision making and emotion regulation:A review of convergent neurocognitive substrates.Behavioural Brain Research,217(1),215–231.

Morris,J.S.,?hman,A.,&Dolan,R.J.(1998).Conscious and unconscious emotional learning in the human amygdala.Nature,393(6684),467–470.

Morris,R.W.,Sparks,A.,Mitchell,P.B,Weickert,C.S.,&Green,M.J.(2012).Lack of cortico-limbic coupling in bipolar disorder and schizophrenia during emotion regulation.Translational Psychiatry,2(3),e90.

Mothersill,O.,Morris,D.W.,Kelly,S.,Rose,E.J.,Fahey,C.,O'Brien,C.,… Donohoe,G.(2014).Effects ofMIR137on fronto-amygdala functional connectivity.Neuroimage,90,189–195.

Mukherjee, P., Whalley, H. C., McKirdy, J. W.,Sprengelmeyer,R.,Young,A.W.,McIntosh,A.M.,…Hall,J.(2014).Altered amygdala connectivity within the socialbrain in schizophrenia.Schizophrenia Bulletin,40(1),152–160.

Murakoshi,K.,&Saito,M.(2009).A neural circuit model of emotional learning using two pathways with different granularity and speed of information processing.BioSystems,95(2),150–154.

Namiki,C.,Hirao,K.,Yamada,M.,Hanakawa,T.,Fukuyama,H.,Hayashi,T.,&Murai,T.(2007).Impaired facial emotion recognition and reduced amygdalar volume in schizophrenia.Psychiatry Research:Neuroimaging,156(1),23–32.

Nolen-Hoeksema, S. (2012). Emotion regulation and psychopathology:The role of gender.Annual Review of Clinical Psychology,8,161–187.

O'Driscoll,C.,Laing,J.,&Mason,O.(2014).Cognitive emotion regulation strategies,alexithymia and dissociation in schizophrenia,a review and meta-analysis.Clinical Psychology Review,34(6),482–495.

Opitz,P.C.,Gross,J.J.,&Urry,H.L.(2012).Selection,optimization,and compensation in the domain of emotion regulation:Applications to adolescence,older age,and major depressive disorder.Social and Personality Psychology Compass,6(2),142–155.

Parkinson,B.,&Totterdell,P.(1999).Classifying affectregulation strategies.Cognition and Emotion,13(3),277–303.Perez,C.R.,&Soto,J.A.(2011).Cognitive reappraisal in the context of oppression:Implications for psychological functioning.Emotion,11(3),675–680.

Perry,Y.,Henry,J.D.,&Grisham,J.R.(2011).The habitual use of emotion regulation strategies in schizophrenia.British Journal of Clinical Psychology,50(2),217–222.

Perry,Y.,Henry,J.D.,Nangle,M.R.,&Grisham,J.R.(2012).Regulation of negative affect in schizophrenia:The effectiveness of acceptance versus reappraisal and suppression.Journal of Clinical And Experimental Neuropsychology,34(5),497–508.

Petermann, F., & Kullik, A. (2011). Frühe Emotionsdysregulation: Ein Indikator für psychische St?rungen im Kindesalter?Kindheit und Entwicklung,20(3),186–196.

Pinkham,A.E.,Gur,R.E.,&Gur,R.C.(2007).Affect recognition deficits in schizophrenia:Neural substrates and psychopharmacological implications.Expert Review of Neurotherapeutics,7(7),807–816.

Pinkham,A.E.,Liu,P.Y.,Lu,H.Z.,Kriegsman,M.,Simpson,C.,&Tamminga,C.(2015).Amygdala hyperactivity at rest in paranoid individuals with schizophrenia.American Journal of Psychiatry,172(8),784–792.

Pizzagalli,D.,Regard,M.,&Lehmann,D.(1999).Rapid emotional face processing in the human right and left brain hemispheres:An ERP study.Neuroreport,10(13),2691–2698.

Pizzagalli,D.A.,Greischar,L.L.,&Davidson,R.J.(2003).Spatio-temporal dynamics of brain mechanisms in aversive classical conditioning: High-density event-related potential and brain electrical tomography analyses.Neuropsychologia,41(2),184–194.

Reber,C.A.S.,Boden,M.T.,Mitragotri,N.,Alvarez,J.,Gross,J.J.,&Bonn-Miller,M.O.(2013).A prospective investigation of mindfulness skills and changes in emotion regulation among military veterans in posttraumatic stress disorder treatment.Mindfulness,4(4),311–317.

Renard,S.B.,Pijnenborg,M.,&Lysaker,P.H.(2012).Dissociation and social cognition in schizophrenia spectrum disorder.Schizophrenia Research,137(1-3),219–223.

Richards,J.M.,Butler,E.A.,&Gross,J.J.(2003).Emotion regulation in romantic relationships: The cognitive consequences of concealing feelings.Journal of Social and Personal Relationships,20(5),599–620.

Richards,J.M.,&Gross,J.J.(2000).Emotion regulation and memory:The cognitive costs of keeping one's cool.Journal of Personality and Social Psychology,79(3),410–424.Righart,R.,&de Gelder,B.(2006).Context influences early perceptual analysis of faces–an electrophysiological study.Cerebral Cortex,16(9),1249–1257.

Ritsner,M.S.,Arbitman,M.,&Lisker,A.(2011).Anhedonia is an important factor of health-related quality-of-life deficit in schizophrenia and schizoaffective disorder.The Journal of Nervous and Mental Disease,199(11),845–853.

Roberts,N.A.,Levenson,R.W.,&Gross,J.J.(2008).Cardiovascular costs of emotion suppression cross ethnic lines.International Journal of Psychophysiology,70(1),82–87.

Rodrigues,S.M.,Schafe,G.E.,&LeDoux,J.E.(2004).Molecular mechanisms underlying emotional learning and memory in the lateral amygdala.Neuron,44(1),75–91.

Ruiz,S.,Lee,S.,Soekadar,S.R.,Caria,A.,Veit,R.,Kircher,T.,…Sitaram,R.(2013).Acquired self-control of insula cortex modulates emotion recognition and brain network connectivity in schizophrenia.Human Brain Mapping,34(1),200–212.

Samson,A.C.,Huber,O.,&Gross,J.J.(2012).Emotion regulation in asperger's syndrome and high-functioning autism.Emotion,12(4),659–665.

Sanchez,A.H.,Lavaysse,L.M.,Starr,J.N.,&Gard,D.E.(2014).Daily life evidence of environment-incongruent emotion in schizophrenia.Psychiatry Research,220(1-2),89–95.

Schipper,M.,&Petermann,F.(2013).Relating empathy and emotion regulation:Do deficits in empathy trigger emotion dysregulation?Social Neuroscience,8(1),101–107.

Sheppes,G.,Scheibe,S.,Suri,G.,Radu,P.,Blechert,J.,&Gross,J.J.(2014).Emotion regulation choice:A conceptual framework and supporting evidence.Journal of Experimental Psychology:General,143(1),163–181.

Soto,J.A.,Perez,C.R.,Kim,Y.-H.,Lee,E.A.,&Minnick,M.R.(2011).Is expressive suppression always associated with poorer psychological functioning?A cross-cultural comparison between European Americans and Hong Kong Chinese.Emotion,11(6),1450–1455.

Strauss,G.P.,Kappenman,E.S.,Culbreth,A.J.,Catalano,L.T.,Lee,B.G.,&Gold,J.M.(2013).Emotion regulation abnormalities in schizophrenia: Cognitive change strategies fail to decrease the neural response to unpleasant stimuli.Schizophrenia Bulletin,39(4),872–883.

Strauss,G.P.,Kappenman,E.S.,Culbreth,A.J.,Catalano,L.T.,Ossenfort,K.L.,Lee,B.G.,&Gold,J.M.(2015).Emotion regulation abnormalities in schizophrenia:Directed attention strategies fail to decrease the neurophysiological response to unpleasant stimuli.Journal of Abnormal Psychology,124(2),288–301.

Stussi,Y.,Brosch,T.,&Sander,D.(2015).Learning to fear depends on emotion and gaze interaction:The role of self-relevance in fear learning.Biological Psychology,109,232–238.

Subic-Wrana,C.,Beutel,M.E.,Br?hler,E.,St?bel-Richter,Y.,Knebel,A.,Lane,R.D.,&Wiltink,J.(2014).How is emotional awareness related to emotion regulation strategies and self-reported negative affect in the general population?PLoS One,9(3),e91846.

Suls,J.,&Bunde,J.(2005).Anger,anxiety,and depression as risk factors for cardiovascular disease:The problems and implications of overlapping affective dispositions.Psychological Bulletin,131(2),260–300.

Surguladze,S.,Russell,T.,Kucharska-Pietura,K.,Travis,M.J.,Giampietro,V.,David,A.S.,&Phillips,M.L.(2006).A reversal of the normal pattern of parahippocampal response to neutral and fearful faces is associated with reality distortion in schizophrenia.Biological Psychiatry,60(5),423–431.

Tan,H.,Ahmad,T.,Loureiro,M.,Zunder,J.,&Laviolette,S.R.(2014).The roleofcannabinoid transmission in emotional memory formation:Implications for addiction and schizophrenia.Frontiers in Psychiatry,5,73.

Taylor,S.F.,Kang,J.,Brege,I.S.,Tso,I.F.,Hosanagar,A.,& Johnson,T.D.(2012).Meta-analysis of functional neuroimaging studies of emotion perception and experience in schizophrenia.Biological Psychiatry,71(2),136–145.

Taylor,S.F.,Liberzon,I.,Decker,L.R.,&Koeppe,R.A.(2002).A functionalanatomic study ofemotion in schizophrenia.Schizophrenia Research,58(2-3),159–172.

Taylor,S.F.,&MacDonald,A.W.(2012).Brain mapping biomarkers of socio-emotional processing in schizophrenia.Schizophrenia Bulletin,38(1),73–80.

Thayer,R.E.,Newman,J.R.,&McClain,T.M.(1994).Self-regulation of mood:Strategies for changing a bad mood,raising energy,and reducing tension.Journal of Personality and Social Psychology,67(5),910–925.

Thomas,N.,Ribaux,D.,&Phillips,L.J.(2014).Rumination,depressive symptoms and awareness of illness in schizophrenia.Behavioural and Cognitive Psychotherapy,42(2),143–155.

Townsend,J.,&Altshuler,L.L.(2012).Emotion processing and regulation in bipolar disorder:A review.Bipolar Disorders,14(4),326–339.

Trémeau,F.(2006).A review ofemotion deficitsin schizophrenia.Dialogues in Clinical Neuroscience,8(1),59–70.

van der Meer,L.,Swart,M.,van der Velde,J.,Pijnenborg,G.,Wiersma,D.,Bruggeman,R.,&Aleman,A.(2014).Neural correlates of emotion regulation in patients with schizophrenia and non-affected siblings.PLoS One,9(6),e99667.

van der Meer,L.,van’t Wout,M.,&Aleman,A.(2009).Emotion regulation strategies in patients with schizophrenia.Psychiatry Research,170(2-3),108–113.

Vanderhasselt,M.-A.,Koster,E.H.W.,Onraedt,T.,Bruyneel,L.,Goubert,L.,&De Raedt,R.(2014).Adaptive cognitive emotion regulation moderates the relationship between dysfunctional attitudes and depressive symptoms during a stressful life period:A prospective study.Journal of Behavior Therapy and Experimental Psychiatry,45(2),291–296.

van Os,J.,Kenis,G.,& Rutten,B.P.F.(2010).The environment and schizophrenia.Nature,468(7321),203–212.

Vance,D.E.,Dodson,J.E.,Watkins,J.,Kennedy,B.H.,&Keltner,N.L.(2013).Neurologicaland psychiatric diseases and their unique cognitive profiles:Implications for nursing practice and research.The Journal of Neuroscience Nursing,45(2),77–87.

Vercammen,A.,Skilleter,A.J.,Lenroot,R.,Catts,S.V.,Weickert,C.S.,&Weickert,T.W.(2013).Testosterone is inversely related to brain activity during emotional inhibition in schizophrenia.PLoS One,8(10),e77496.

Vilardaga,R.,Hayes,S.C.,Atkins,D.C.,Bresee,C.,&Kambiz,A.(2013).Comparing experiential acceptance and cognitive reappraisalaspredictors offunctional outcome in individuals with serious mentalillness.Behaviour Research and Therapy,51(8),425–433.

Wegner,D.M.,Broome,A.,&Blumberg,S.J.(1997).Ironic effects of trying to relax under stress.Behaviour Research and Therapy,35(1),11–21.

Weiss,J.A.,Thomson,K.,&Chan,L.(2014).A systematic literature review of emotion regulation measurement in individuals with autism spectrum disorder.Autism Research,7(6),629–648.

Werner,K.H.,Goldin,P.R.,Ball,T.M.,Heimberg,R.G.,&Gross,J.J.(2011).Assessing emotion regulation in social anxiety disorder: The emotion regulation interview.Journal of Psychopathology and Behavioral Assessment,33(3),346–354.

Westermann,S.,Boden,M.T.,Gross,J.J.,&Lincoln,T.M.(2013).Maladaptive cognitive emotion regulation prospectively predicts subclinicalparanoia.Cognitive Therapy and Research,37(4),881–885.

Wexler,B.E.,Ikezawa,S.,&Corbera,S.(2014).Increasing stimulus duration can normalize late-positive event related potentials in people with schizophrenia:Possible implications for understanding cognitive deficits.Schizophrenia Research,158(1-3),163–169.

Williams,L.L.M.,Das,P.,Liddell,B.J.,Olivieri,G.,Peduto,A.S.,David,A.S.,…Harris,A.W.F.(2007).Fronto-limbic and autonomic disjunctionsto negative emotion distinguish schizophrenia subtypes.Psychiatry Research:Neuroimaging,155(1),29–44.

Wong,J.,Morrison,A.S.,Heimberg,R.G.,Goldin,P.R.,&Gross,J.J.(2014).Implicit associations in social anxiety disorder:The effects of comorbid depression.Journal of Anxiety Disorders,28(6),537–546.

Wynn,J.K.,Jahshan,C.,Altshuler,L.L.,Glahn,D.C.,&Green,M.F.(2013).Event-related potential examination of facialaffectprocessing in bipolar disorder and schizophrenia.Psychological Medicine,43(1),109–117.

Yan,C.,Yang,T.,Yu,Q.J.,Jin,Z.,Cheung,E.F.C.,Liu,X.,& Chan,R.C.K.(2015).Rostral medial prefrontal dysfunctions and consummatory pleasure in schizophrenia:A meta-analysis of functional imaging studies.Psychiatry Research:Neuroimaging,231(3),187–196.