Emotional Experience in Patients With Schizophrenia Revisited: Meta-analysis of Laboratory Studies

Department of Psychology, Louisiana State University, 206 Audubon Hall Baton Rouge, LA 708080, USA.
Schizophrenia Bulletin (Impact Factor: 8.45). 07/2008; 36(1):143-50. DOI: 10.1093/schbul/sbn061
Source: PubMed


Our understanding of the emotion deficits in schizophrenia is limited. Findings from studies employing trait emotion instruments
suggest that patients have attenuated levels of positive emotion (ie, anhedonia) and increased levels of negative emotion.
Conversely, patients and controls have not statistically differed in their subjective reactions to positive or negative valenced
stimuli in most laboratory studies to date. Further obfuscating this issue is the fact that many of these laboratory studies
are underpowered and a handful of emotion induction studies have found evidence of anhedonia. We conducted a meta-analysis
of 26 published studies employing laboratory emotion induction procedures in patients with schizophrenia and healthy controls.
Patients did not differ from controls when strictly rating their subjective hedonic reactions to the stimuli. However, they
reported experiencing relatively strong aversion to both positive and neutral stimuli (Hedges D = .72 and .64, respectively). These findings were not the result of demonstrable sample or methodological differences across
studies. Patients’ ability to experience hedonic emotion is preserved, although they also show relatively strong, simultaneously
occurring aversive emotion when processing laboratory stimuli considered by others to be pleasant or neutral.

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Available from: Alex S Cohen, Jan 06, 2014
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    • "Furthermore, evidence suggests that psychosis patients experience strong aversive emotion when processing neutral stimuli [60] [12]. Instead of an impairment for neutral valence recognition, this aversive response may reveal an interpretative bias where neutral/ambiguous stimuli are processed as negative. "
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    ABSTRACT: A key factor in the transition to psychosis is the appraisal of anomalous experiences as threatening. Cognitive models of psychosis have identified attentional and interpretative biases underlying threat-based appraisals. While much research has been conducted into these biases within the clinical and cognitive literature, little examination has occurred at the neural level. However, neurobiological research in social cognition employing threatening stimuli mirror cognitive accounts of maladaptive appraisal in psychosis. This review attempted to integrate neuroimaging data regarding social cognition in psychosis with the concepts of attentional and interpretative threat biases. Systematic review methodology was used to identify relevant articles from Medline, PsycINFO and EMBASE, and PubMed databases. The selective review showed that attentional and interpretative threat biases relate to abnormal activation of a range of subcortical and prefrontal structures, including the amygdala, insula, hippocampus, anterior cingulate, and prefrontal cortex, as well as disrupted connectivity between these regions, when processing threatening and neutral or ambiguous stimuli. Notably, neural findings regarding the misattribution of threat to neutral or ambiguous stimuli presented a more consistent picture. Overall, however, the findings for any specific emotion were mixed, both in terms of the specific brain areas involved and the direction of effects (increased/decreased activity), possibly owing to confounds including small sample sizes, varying experimental paradigms, medication, and heterogeneous, in some cases poorly characterised, patient groups. Further neuroimaging research examining these biases by employing experimentally induced anomalous perceptual experiences and well-characterised large samples is needed for greater aetiological specificity.
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    • "Anxiety, worry and misattribution of threat to neutral social stimuli have been hypothesized to elicit and further maintain delusion formation and/or hallucinogenesis in paranoid schizophrenia psychoses [16] [21] [48] [49] [50] [51] [52]. Consistent with clinical observations and theoretical hypotheses, a meta-analysis of laboratory studies has found that schizophrenic patients experience relatively stronger aversion to neutral stimuli [53]. Moreover, within the categorical model of emotions, which implies a differentiation between a limited number of basic emotions [54] [55], analyses of error patterns have discovered that neutral emotional expressions are misperceived (misinterpreted) as fearful by stable remitted [56] or as angry by acutely paranoid [57] schizophrenic patients. "
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    ABSTRACT: We have recently found that patients with paranoid schizophrenia experience abnormally elevated subjective emotional arousal (SEA) in response to low-arousing/neutral but not to high-arousing/aversive social scenes. The aim of the present study was to test an explanation of this finding by exploring the relative contributions of psychosis and antipsychotic pharmacotherapy. We compared the SEA to the same two types of stimuli in 15 actively psychotic and 15 therapeutically improved post-psychotic inpatients with paranoid schizophrenia contrasted to 30 healthy controls. The results revealed that the SEA to the neutral stimuli was significantly higher in the psychotic than in the post-psychotic subgroup, being abnormally high in both of them relative to controls. Conversely, their SEA to the aversive stimuli was as high as that of the controls. Additionally, we demonstrated that during psychosis the patients experience low-arousing/neutral scenes as if they are high-arousing, thus misattributing emotional salience to them. During the post-psychotic phase this deficient differentiation between salient and nonsalient stimuli is partially restored. We discussed how these findings and their explanations could bridge the gap between objective neurobiological and subjective psychological mechanisms of psychotic-symptom formation and antipsychotic-treatment response, respectively. We argued that an elevated endogenous SEA underlies subjective symptoms of psychosis and accordingly is a key target for antipsychotic pharmacotherapy. We further proposed a practical application of our simple SEA-rating-task as a promising neurobehavioral probe for fMRI studies of these mechanisms as well as a potential surrogate endpoint measure of antipsychotic-treatment response, including in clinical trials of novel antipsychotic drugs.
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    • "Therefore , it is not possible to determine whether the experienced emotions were ' pure , ' undifferentiated or mixed . In this context , the insight - ful observation that in persons with SZ , positive and neutral stimuli may " co - activate hedonic and aversive emotions " seems particularly relevant ( Cohen and Minor , 2010 ) . "
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    ABSTRACT: Adaptive emotional responses are important in interpersonal relationships. We investigated self-reported emotional experience, physiological reactivity, and micro-facial expressivity in relation to the social nature of stimuli in individuals with schizophrenia (SZ). Galvanic skin response (GSR) and facial electromyography (fEMG) were recorded in medicated outpatients with SZ and demographically matched healthy controls (CO) while they viewed social and non-social images from the International Affective Pictures System. Participants rated the valence and arousal, and selected a label for experienced emotions. Symptom severity in the SZ and psychometric schizotypy in CO were assessed. The two groups did not differ in their labeling of the emotions evoked by the stimuli, but individuals with SZ were more positive in their valence ratings. Although self-reported arousal was similar in both groups, mean GSR was greater in SZ, suggesting differential awareness, or calibration of internal states. Both groups reported social images to be more arousing than non-social images but their physiological responses to non-social vs. social images were different. Self-reported arousal to neutral social images was correlated with positive symptoms in SZ. Negative symptoms in SZ and disorganized schizotypy in CO were associated with reduced mean fEMG. Greater corrugator mean fEMG activity for positive images in SZ indicates valence-incongruent facial expressions. The patterns of emotional responses differed between the two groups. While both groups were in broad agreement in self-reported arousal and emotion labels, their mean GSR, and fEMG correlates of emotion diverged in relation to the social nature of the stimuli and clinical measures. Importantly, these results suggest disrupted self awareness of internal states in SZ and underscore the complexities of emotion processing in health and disease.
    Frontiers in Psychology 04/2015; 6. DOI:10.3389/fpsyg.2015.00320 · 2.80 Impact Factor
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