Awareness and rumination moderate the affective pathway to paranoia in daily life

Numerous cross-sectional studies found psychosis to be associated with less awareness of emotions, a decreased use of adaptive (e.g. reappraisal) and an increased use of maladaptive emotion regulation (ER) strategies (e.g. suppression). In this study, we tested whether state levels of emotion awareness and momentary use of specific ER strategies moderate the link between negative affect at one timepoint (t-1) and paranoia at the next timepoint (t) in a six-day experience sampling study. Individuals with psychotic disorders (n = 71) reported on the presence of paranoia, negative affect, emotion awareness and the use of six ER strategies (reappraisal, acceptance, social sharing, distraction, suppression and rumination) ten times per day. Multilevel regression analysis revealed that higher awareness at t-1 reduced the association of negative affect at t-1 and paranoia at t, whereas rumination had an opposite, amplifying moderation effect. Our results provide novel insight into the conditions under which negative affect translates into delusional beliefs. The finding that emotion awareness and rumination have a relevant role corresponds with current psychological conceptualisations of psychosis and with the attempt to treat delusions by focusing on reducing ruminative thoughts. To investigate the causal effect, treatment trials with a focus on enhancing these components of emotion regulation are needed.