The Mediating Role of Difficulty in Emotion Regulation in the Relationship Between Traumatic Life Events and Character With Negative Symptoms of Schizophrenia

Hadi Razmyar; Ahmad Mansouri; Qasem Ahi; Seyed Abdolmajid Bahreinian; Fahime Saied

doi:10.61838/kman.jndd.3.2.13

Authors

Hadi Razmyar Department of Psychology, Birjand Branch, Islamic Azad University, Birjand, Iran Author https://orcid.org/0009-0003-0322-7403
Ahmad Mansouri Department of Psychology, Neyshabur Branch, Islamic Azad University, Neyshabur, Iran Corresponding author https://orcid.org/0000-0003-3944-4082
Qasem Ahi Department of Psychology, Birjand Branch, Islamic Azad University, Birjand, Iran Author https://orcid.org/0000-0002-2772-7053
Seyed Abdolmajid Bahreinian Department of Psychology, Birjand Branch, Islamic Azad University, Birjand, Iran Author https://orcid.org/0000-0002-1499-3715
Fahime Saied Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran Author https://orcid.org/0000-0002-0214-3887

DOI:

https://doi.org/10.61838/kman.jndd.3.2.13

Keywords:

Character, difficulty in emotion regulation, negative symptoms, schizophrenia

Abstract

This study aimed to investigate the mediating role of difficulty in emotion regulation in the relationship between traumatic life events and character with negative symptoms of schizophrenia. The research method was quantitative, fundamental, cross-sectional, descriptive, and correlational. The statistical population included all people with schizophrenia hospitalized in Razi Psychiatric Hospital in 2023-2024, of which 200 people were selected by convenience sampling. The data collection tools included the Positive and Negative Symptom Scale, the Temperament and Character Inventory, the Trauma History Questionnaire, and the Short Form of Difficulty in Emotion Regulation. SPSS and AMOS software were used to analyze the data, as well as Pearson correlation and structural equation modeling. The direct coefficient analysis showed that the relationship between traumatic life events and difficulty in emotion regulation with negative symptoms of schizophrenia was significant. Another finding of the study showed that the direct effect of traumatic life events and character on difficulty in emotion regulation was significant. Indirect coefficients indicated that the indirect effect of traumatic life events and character on negative symptoms of schizophrenia was significant with the mediating role of difficulty in emotion regulation. Finally, the present study's model had a favorable fit (CFI=0.97, NFI=0.95, IFI=0.97, GFI=0.97, RMSEA=0.071). Therefore, emotion regulation training can be considered an important approach to treating the challenging task of schizophrenia's negative symptoms.

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References

Adan, A., Serra-Grabulosa, J. M., Caci, H., & Natale, V. (2009). A reduced Temperament and Character Inventory (TCI-56). Psychometric properties in a non-clinical sample. Personality and individual differences,46(7), 687-692. https://doi.org/10.1016/j.paid.2009.01.023Anglin, D. M., Ereshefsky, S., Klaunig, M. J., Bridgwater, M. A., Niendam, T. A., Ellman, L. M., & van der Ven, E. (2021). From womb to neighborhood: a racial analysis of social determinants of psychosis in the United States. American Journal of Psychiatry,178(7), 599-610. https://doi.org/10.1176/appi.ajp.2020.20071091Bartolomeo, L. A., Chapman, H. C., Raugh, I. M., & Strauss, G. P. (2021). Delay discounting in youth at clinical high-risk for psychosis and adults with schizophrenia. Psychological medicine,51(11), 1898-1905. https://doi.org/10.1017/S0033291720000677Bartolomeo, L. A., Raugh, I. M., & Strauss, G. P. (2022). Deconstructing emotion regulation in schizophrenia: The nature and consequences of abnormalities in monitoring dynamics. Schizophrenia Research,240, 135-142. https://doi.org/10.1016/j.schres.2021.12.043Campodonico, C., Varese, F., & Berry, K. (2022). Trauma and psychosis: a qualitative study exploring the perspectives of people with psychosis on the influence of traumatic experienceson psychotic symptoms and quality of life. BMC psychiatry,22(1), 213. https://doi.org/10.1186/s12888-022-03808-3Căpățînă, O. O., Micluția, I. V., & Fadgyas-Stănculete, M. (2021). Current perspectives in treating negative symptoms of schizophrenia: A narrative review (Review). Experimental and Therapeutic Medicine,21(3), 276. https://doi.org/10.3892/etm.2021.9707Chae, H., Park, S. H., Garcia, D., & Lee, S. J. (2019). Cloninger's TCI associations with adaptive and maladaptive emotion regulation strategies. Peerj,7, e7958. https://doi.org/10.7717/peerj.7958Cloninger, C. R., Svrakic, D. M., & Przybeck, T. R. (1993). A psychobiological model of temperament and character. Archives of General Psychiatry,50(12), 975-990. https://doi.org/10.1001/archpsyc.1993.01820240059008Cloninger, C. R., & Zohar, A. H. (2011). Personality and the perception of health and happiness. Journal of affective disorders,128(1-2), 24-32. https://doi.org/10.1016/j.jad.2010.06.012Conrad, R., Schilling, G., Bausch, C., Nadstawek, J., Wartenberg, H. C., Wegener, I., Geiser, F., Imbierowicz, K., & Liedtke, R. (2007). Temperament and character personality profiles and personality disorders in chronic pain patients. Pain,133(1-3), 197-209. https://doi.org/10.1016/j.pain.2007.07.024Conti, L., Fantasia, S., Violi, M., Dell'Oste, V., Pedrinelli, V., & Carmassi, C. (2023). Emotional Dysregulation and Post-Traumatic Stress Symptoms: Which Interaction in Adolescents and Young Adults? A Systematic Review. Brain Sciences,13(12), 1730. https://doi.org/10.3390/brainsci13121730De Fruyt, F., Van de Wiele, L., & Van Heeringen, C. (2000). Cloninger's psychobiological model of temperament and character and the five-factor model of personality. Personality and individual differences,29(3), 441-452. https://doi.org/10.1016/S0191-8869(99)00204-4Donaldson, K. R., Jonas, K. G., Tian, Y., Larsen, E. M., Klein, D. N., Mohanty, A., & Kotov, R. (2022). Dynamic interplay between life events and course of psychotic disorders: 10-year longitudinal study following first admission. Psychological medicine,52(11), 2116-2123. https://doi.org/10.1017/S0033291720003992Duru, E., & Balkıs, M. (2024). COVID-19 related negative life events and psychological distress: the role of emotion and cognitive emotion regulation strategies. Journal of Rational-Emotive & Cognitive-Behavior Therapy,42(1), 69-91. https://doi.org/10.1007/s10942-022-00488-6Eley, D. S., Cloninger, C. R., Walters, L., Laurence, C., Synnott, R., & Wilkinson, D. (2013). The relationship between resilience and personality traits in doctors: Implications for enhancing well being. Peerj,1, e216. https://doi.org/10.7717/peerj.216Fitzpatrick, S., Dixon-Gordon, K. L., Turner, C. J., Chen, S. X., & Chapman, A. (2023). Emotion Dysregulation in Personality Disorders. Current psychiatry reports,25(5), 223-231. https://doi.org/10.1007/s11920-023-01418-8Galderisi, S., Kaiser, S., Bitter, I., Nordentoft, M., Mucci, A., Sabé, M., & Gaebel, W. (2021). EPA guidance on treatment of negative symptoms in schizophrenia. European Psychiatry,64(1), e21. https://doi.org/10.1192/j.eurpsy.2021.13Galderisi, S., Mucci, A., Bitter, I., Libiger, J., Bucci, P., Fleischhacker, W. W., & Eufest Study, G. (2013). Persistent negative symptoms in first episode patients with schizophrenia: results from the European First Episode Schizophrenia Trial. European Neuropsychopharmacology,23(3), 196-204. https://doi.org/10.1016/j.euroneuro.2012.04.019Gawęda, Ł., Prochwicz, K., & Cella, M. (2015). Cognitive biases mediate the relationship between temperament and character and psychotic-like experiences in healthy adults. Psychiatry research,225(1-2), 50-57. https://doi.org/10.1016/j.psychres.2014.10.006Ghamari Givi, H., Moulavi, P., & Heshmati, R. (2010). Exploration of the factor structure of positive and negative syndrome scale in schizophernia spectrum disorder. Journal of Clinical Psychology,2(2), 1-10. https://doi.org/10.22075/jcp.2017.2018Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of psychopathology and behavioral assessment,26, 41-54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94Green, B. L. (1996). Trauma History Questionnaire. In B. H. Stamm (Ed.), Measurement of stress, trauma, and adaptation(pp. 366-369). Sidran Press. Hammen, C. (2006). Stress generation in depression: Reflections on origins, research, and future directions. Journal of Clinical Psychology,62(9), 1065-1082. https://doi.org/10.1002/jclp.20293Hillow, M. A., Atwoli, L., & Kwobah, E. K. (2023). Association between TraumaticLife Events and Psychosis: A case-control study in western Kenya. Heliyon,9(7). https://doi.org/10.1016/j.heliyon.2023.e18144Josefsson, K., Jokela, M., Cloninger, C. R., Hintsanen, M., Salo,J., Hintsa, T., & Keltikangas-Järvinen, L. (2013). Maturity and change in personality: developmental trends of temperament and character in adulthood. Development and Psychopathology,25(3), 713-727. https://doi.org/10.1017/S0954579413000126Kaufman, E. A., Xia, M., Fosco, G., Yaptangco, M., Skidmore, C. R., & Crowell, S. E. (2016). The Difficulties in Emotion Regulation Scale Short Form (DERS-SF): Validation and replication in adolescent and adultsamples. Journal of psychopathology and behavioral assessment,38(3), 443-455. https://doi.org/10.1007/s10862-015-9529-3Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin,13(2), 261-276. https://doi.org/10.1093/schbul/13.2.261Kendler, K. S. (2020). Eugen Bleuler’s Views on the Genetics of Schizophreniain 1917. Schizophrenia Bulletin,46(4), 758-764. https://doi.org/10.1093/schbul/sbz131Khoramimanesh, S., & Mansouri, A. (2019). The mediating role of cognitive emotion regulation and spiritual copingin the relationship between the history of trauma and symptoms of borderline personality. Journal of Research in Behavioural Sciences,17(1), 1-11. http://rbs.mui.ac.ir/article-1-639-fa.htmlKilian, C., Supanya, S., Probst, C., Morgan, C., Bärnighausen, T., Kittirattanapaiboon, P., Kwansanit, P., Reininghaus, U., & Thai Mental Health Survey Working, G. (2021). Traumatic events and psychotic experiences: a nationally representative study in Thailand. Epidemiology and Psychiatric Sciences,30, e47. https://doi.org/10.1017/S2045796021000172Kimhy, D., Lister, A., Liu, Y., Vakhrusheva, J., Delespaul, P., Malaspina, D., & Wang, Y. (2020). The impact of emotion awareness and regulation on psychotic symptoms during daily functioning. npj Schizophrenia,6(1), 7. https://doi.org/10.1038/s41537-020-0096-6Lee, S. J., Choi, Y. J., & Chae, H. (2017). The effects of personality traits on academic burnout in Korean medical students. Integrative Medicine Research,6(2), 207-213. https://doi.org/10.1016/j.imr.2017.03.005Liu, J., Chua, J. J., Chong, S. A., Subramaniam, M., & Mahendran, R. (2020). The impact of emotion dysregulation on positive and negative symptoms in schizophrenia spectrum disorders: A systematic review. Journal of Clinical Psychology,76(4), 612-624. https://doi.org/10.1002/jclp.22915Liu, J., Lim, M. S. M., Ng, B. T., Chong, S. A., Subramaniam, M., & Mahendran, R. (2020).Global emotion dysregulation and maladaptive cognitive emotion regulation strategies mediate the effects of severe trauma on depressive and positive symptoms in early non-affective psychosis. Schizophrenia Research,222, 251-257. https://doi.org/10.1016/j.schres.2020.05.040Lotfi, M., & Amini, M. (2019). The role of temperament and character of personality in predicting emotion regulation in patients with emotional disorders. Journal of MilitaryMedicine,21(5), 490-498. Ma, Y., Chiappelli, J., Kvarta, M. D., Bruce, H., van der Vaart, A., Goldwaser, E. L., & Hong, L. E. (2023). Effects of independent versus dependent stressful life events on major symptom domains of schizophrenia. Schizophrenia,9(1), 84. https://doi.org/10.1038/s41537-023-00415-3McCutcheon, R. A., Marques, T. R., & Howes, O. D. (2020). Schizophrenia—an overview. JAMA Psychiatry,77(2), 201-210. https://doi.org/10.1001/jamapsychiatry.2019.3360Meshkasar, M. (2017). Predicting cognitive emotion regulation based on personality traits and temperament dimensionsIslamic Azad University, Marvdasht Branch]. Faculty of Educational Sciences and Psychology. Mosolov, S., & Yaltonskaya, P. A. (2020). Concept, classification and clinical differentiation of negative symptoms in schizophrenia. Current Therapy of Mental Disorders,1, 2-12. https://doi.org/10.21265/PSYPH.2020.15.30.001Mosolov, S. N., & Yaltonskaya, P. A. (2022). Primary and secondary negative symptoms in schizophrenia. Frontiers in Psychiatry,12, 766692. https://doi.org/10.3389/fpsyt.2021.766692Mucci, A., Galderisi, S., Gibertoni, D., Rossi, A., Rocca, P., Bertolino, A., & Del Favero, E. (2021). Factors associated with real-life functioning in persons with schizophrenia in a 4-year follow-up study of the Italian network for research on psychoses. JAMA Psychiatry,78(5), 550-559. https://doi.org/10.1001/jamapsychiatry.2020.4614

Nabizadeh asl, D., Ahi, Q., Shahabizadeh, F., & Mansouri, A. (2020). The Mediating Role of Cognitive Emotion Regulation, Cognitive Biases, and Negative Schemas in the Relationship between Traumatic Childhood Experiences and Psychotic-Like Experiences. Journal of Research in Behavioural Sciences,18(3), 320-335. http://rbs.mui.ac.ir/article-1-836-fa.htmlNuechterlein, K. H., & Dawson, M. E. (1984). A heuristic vulnerability/stress model of schizophrenic episodes. Schizophrenia Bulletin,10(2), 300-312. https://doi.org/10.1093/schbul/10.2.300O'Driscoll, C., Laing, J., & Mason, O. (2014). Cognitive emotion regulation strategies, alexithymia and dissociation in schizophrenia, a review and meta-analysis. Clinical psychology review,34(6), 482-495. Popovic, D., Schmitt, A., Kaurani, L., Senner, F., Papiol, S., Malchow, B., & Falkai, P. (2019). Childhood trauma in schizophrenia: current findings and research perspectives. Frontiers in Neuroscience,13, 274. https://doi.org/10.3389/fnins.2019.00274Rabinowitz, J., Werbeloff, N., Caers, I., Mandel, F. S., Stauffer, V., Menard, F., & Kapur, S. (2013). Negative symptoms in schizophrenia–the remarkable impact of inclusion definitions in clinical trials and their consequences. Schizophrenia Research,150(2-3), 334-338. https://doi.org/10.1016/j.schres.2013.06.023Rajabi Marandian, S., Talebzadeh, M., & Jairvand, H. (2023). Causal relationship of nature and character with internalized and externalized signs of adolescents with the mediating role of cognitive emotion regulation. Psychological Achievements. https://doi.org/10.22055/psy.2023.43950.3056Ranjbar Noushari, F., Abolghasemi, A., Baradaran, M., Asadi Majreh, S., & Mowlaie, M. (2022). Reliability and Validation of the Short Version of the Temperament and Character Inventory (TCI-56) in University Student. Knowledge & Research in Applied Psychology,22(4), 58-75. https://www.magiran.com/p2425412Río-Martínez, L., Marquez-Arrico, J. E., Prat, G., & Adan, A. (2020). Temperament and character profile and its clinical correlates in male patients with dual schizophrenia. Journal of clinical medicine,9(6), 1876. https://doi.org/10.3390/jcm9061876Sedighi, M., Mansouri, A., & Talaei, A. (2019). The relationship between transdiagnostic factors and psychotic symptoms in individual with schizophrenia disorder. Journal of Fundamentals of Mental Health,21(3). https://doi.org/10.22038/jfmh.2019.39008.2632Seery, M. D. (2011). Resilience: A silver lining to experiencing adverse life events? Current Directions in Psychological Science,20(6), 390-394. https://doi.org/10.1177/096372141142474Shamsabadi, A., Ahi, Q., Bahreinian,S. A., Mansouri, A., & Shahabizadeh, F. (2023). The Mediating Role of Difficulties in Emotion Regulation and Personality Organization in the Relationship between Object Relations and Non-suicidal Self-injury. Rooyesh-e-Ravanshenasi Journal (RRJ),12(6), 151-162. http://frooyesh.ir/article-1-4498-fa.htmlSong, Y. Y., Kang, J. I., Kim, S. J., Lee, M. K., Lee, E., & An, S. K. (2013). Temperament and character in individuals at ultra-high risk for psychosis and with first-episode schizophrenia: associations with psychopathology, psychosocial functioning, and aspects of psychological health. Comprehensive Psychiatry,54(8), 1161-1168. https://doi.org/10.1016/j.comppsych.2013.05.015Starkey, C. (2015). Emotion and Character. In C. B. Miller (Ed.), Character: New Directions from Philosophy, Psychology, and Theology. Oxford Academic. https://doi.org/10.1093/acprof:oso/9780190204600.003.0009Tajeryan, Z., Afrooz, G. A., & Nouryghasemabadi, R. (2022). Social Problem Solving in Women with PTSD and Addiction. Psychology of Woman Journal,3(4), 84-91. https://doi.org/10.61838/Tajeryan, Z., Afrooz, G. A., & Nouryghasemabadi, R. (2023). Emotion Regulation in Women with PTSD and Addiction. Psychology of Woman Journal,4(2), 160-168. https://doi.org/10.61838/kman.pwj.4.2.19Tessner, K. D., Mittal, V., & Walker, E. F. (2011). Longitudinal study of stressful life events and daily stressors among adolescents at high risk for psychotic disorders. Schizophrenia Bulletin,37(2), 432-441. https://doi.org/10.1093/schbul/sbp087Uyan, T. T., Baltacioglu, M., & Hocaoglu, C. (2022). Relationships between childhood trauma and dissociative, psychotic symptoms in patients with schizophrenia: a case–control study. General Psychiatry,35(1). https://doi.org/10.1136/gpsych-2021-100659Ware, K., Misiak, B., Hamza, E. A., Nalla, S., & Moustafa, A. A. (2024). The Impact of Childhood Trauma on the Negative Symptoms of Schizophrenia. The Journal of Nervous and Mental Disease,212(9), 460-470. https://doi.org/10.1097/NMD.0000000000001788Zwir, I., Arnedo, J., Del-Val, C., Pulkki-Råback, L., Konte, B., Yang, S. S., & Cloninger, C. R. (2020). Uncovering the complex genetics of human character. Molecular Psychiatry,25(10), 2295-2312. https://doi.org/10.1038/s41380-018-0263-6