Mounting evidence suggests a causal role of negative emotion in delusions. Particularly, fluctuations in anxiety and self-esteem seem to trigger delusional ideation. Consequently, the ability to down-regulate negative emotions is likely to help to prevent or reduce delusional ideation. Despite the clear theoretical relevance, emotion regulation strategies such as reappraisal (i.e. changing the perspective on a situation in order to modify emotional responses) or expressive suppression (i.e. inhibiting facial expressions of emotions; „poker face‟) have not been researched in delusions so far.
The present dissertation project fills this gap by investigating emotion regulation in paranoia- and delusion-prone samples. Study 1 revealed bivariate and multivariate associations between emotion regulation difficulties and paranoia-proneness. Study 2 experimentally demonstrated that delusion-prone individuals had difficulties in successfully applying the emotion regulation strategy reappraisal while watching anxiety-eliciting pictures, but not in applying expressive suppression. Furthermore, unsuccessful emotion regulation was correlated with state delusional ideation exclusively during reappraisal. The potentially maladaptive nature of reappraisal in delusion was further corroborated in study 3. Under social stress, paranoia-prone individuals who habitually use reappraisal experienced an increase in state paranoia.
Taken together, the present dissertation project provides subclinical evidence for specific difficulties in applying the generally helpful and adaptive emotion regulation strategy reappraisal. A working model of emotion regulation in delusions that incorporates a vulnerability-stress-approach, cognitive models of positive symptoms and the process model of emotion regulation was proposed in order to stimulate further theory-driven research in populations with clinically relevant delusions. A preliminary clinical implication might be that reappraisal in social high-stress situations should be applied with caution in delusion-proneness