Neurophysiological Evidence for Emotion Regulation Impairment in Schizophrenia: The Role of Visual Attention and Cognitive Effort

Prior research indicates that individuals with schizophrenia (SZ) display emotion regulation abnormalities that are critically linked to increased symptom severity and poor functional outcome. However, processes contributing to the aberrant implementation of various strategies are unclear. The current study took a multimodal approach to identifying mechanisms underlying the impaired implementation of 2 strategies: reappraisal and distraction. Participants included 25 individuals with SZ and 25 healthy controls (CN) who completed separate event-related potential and eye-tracking/pupil dilation tasks. On each task, participants were required to either passively view unpleasant or neutral stimuli or reduce negative affect using reappraisal or distraction emotion regulation strategies. The late positive potential (LPP) event related potential component was used as an objective neurophysiological indicator of emotion regulation effectiveness. Eye tracking and pupil dilation were used to determine whether the implementation of reappraisal and distraction were associated with abnormal patterns of visual attention and reduced cognitive effort. respectively. Results indicated that CN could effectively decrease the amplitude of the LPP for both reappraisal and distraction compared with unpleasant passive viewing; however, individuals with SZ showed comparable LPP amplitude among conditions, indicating a failure to effectively implement these strategies. In CN, successful down-regulation of negative affect was associated with different patterns of visual attention across regulation strategies. During reappraisal, there was an increase in fixations to arming scene regions, whereas distraction was associated with reduced attention to arousing interest areas. In contrast, individuals with SZ made fewer fixations to arousing interest areas during reappraisal and more fixations to arousing interest areas during distraction. Furthermore, pupil dilation results suggested that individuals with SZ failed to exert adequate effort while implementing reappraisal. Collectively, these findings suggest that individuals with SZ are ineffective at implementing reappraisal and distraction; dysfunctional patterns of visual attention and low cognitive effort may contribute to these difficulties.