Emotion regulation in delusion-proneness: deficits in cognitive reappraisal, but not in expressive suppression

Although anxiety plays a key role in delusions, its downregulation using specific emotion regulation (ER) strategies has not been investigated. Reappraisal has been shown to be one of the most effective strategies for healthy individuals. However, individuals with delusions might have difficulties in successfully applying reappraisal. This study therefore tests the effectiveness of reappraisal compared to expressive suppression in individuals with varying levels of delusion-proneness.

An experimental design with the independent variables ER strategy (within subject) and delusion-proneness (between subject; quasi-experimental) was used. The dependent variables were subjective ER success and physiological arousal, as well as state delusional ideation.

Eighty-six healthy participants with different levels of delusion-proneness were instructed to respond to anxiety-inducing stimuli by either using reappraisal or expressive suppression.

Overall, reappraisal was more effective than expressive suppression in regulating anxiety. However, delusion-prone individuals were less successful in applying reappraisal (interaction effect: F(2,158) = 3.70, p = .027). In addition, lower success in reappraising threat was accompanied by higher state delusional ideation (r = -0.20, p = .013).

Delusion-proneness is accompanied by difficulties in reappraising threat that might contribute to the formation and maintenance of clinically relevant delusions. Preliminary implications for the improvement of cognitive behaviour therapy for delusions are discussed.