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Understanding the role of emotion regulation and self-schemata in acute psychological distress

Early trauma and adversity may affect the emotion regulation ability of affected individuals, and may contribute to negative self-schemata. Clinical experience suggests that psychiatric inpatients are particularly affected by these issues, raising the possibility that psychological interventions in the acute ward need to focus on building emotion regulation skills and addressing negative beliefs about the self. We have investigated these questions in several studies, each of which are outlined below.


Livingstone, Harper & Gillanders (2009)


  • The emotional experience of individuals who experience psychosis has historically been neglected, possibly due to the divide between the psychoses and neuroses. This study examined emotional experience and regulation in individuals who had experienced psychosis, individuals experiencing anxiety or mood disorders, and non-patient controls.

  • Both clinical groups were found to experience similar levels of emotions, and in comparison to the non-patient controls, they experienced greater levels of negatively valenced emotions and lower levels of happiness.

  • Both clinical groups also used similar emotion regulation strategies, and in comparison to non-patient controls, they used significantly more dysfunctional and less functional strategies, suggesting that the emotional experience and emotion regulation strategies of people who have experienced psychosis are more similar to non-psychotic disorders than have previously been thought to be the case.

  • The paper is available here.


Newman-Taylor, Harper & Chadwick (2009)


  • This study reported the effects of mindfulness practice on voice hearing and related distress in two individuals with long-standing distressing voices.

  • Mindfulness was associated with meaningful change in mindfulness ability, belief conviction in relation to voices, and voice-related distress

  • The paper is available here.


Taylor & Harper (2015)


  • Cognitive models of psychosis suggest that negative schema confer vulnerability to and maintain psychotic symptoms. However, few studies have investigated schema among individuals with psychotic symptoms, and research has yet to investigate associations between early maladaptive schema and social functioning and distress. The current preliminary study aimed to investigate these issues.

  • In this cross-sectional study 20 participants with experience of psychosis completed questionnaires measuring early maladaptive schema, social functioning, and global distress.

  • Social functioning was significantly associated with two schema: dependency and enmeshment. Eight schema were significantly associated with distress.

  • These results suggest that early maladaptive schema may have an important role in psychosis, and could be considered as part of psychological therapies that seek to enhance social functioning and reduce distress.

  • The paper is available here.


Harper (2011)


  • This case report illustrates the potential benefits of an integrated cognitive behavioural intervention on an individual with schizoaffective disorder, focusing on improving emotion regulation, compassion and self-schemata.

  • The paper is available here.


Carmichael, Goodall, Harper & Hutton (ongoing)

  • This study is examining whether trauma contributes to persecutory delusions via the formation of negative self-schemata.

  • We are also piloting a novel interview-based assessment of schemata, using this to validate responses to a widely-used questionnaire measure of this outcome.

Carmichael, Goodall, Harper & Hutton (ongoing)

  • This systematic review and meta-analysis is examining the extent to which specific forms of childhood trauma (sexual, physical and emotional abuse; physical and emotional neglect) are related to paranoia severity in people with persecutory delusions, taking into account study and outcome quality.

  • The protocol for this review is available here.

Woodrow, Karatzias, Harper, Fleming & Hutton (ongoing)

  • This randomised controlled trial will use 'ecological interventionist-causal' methodology to examine whether a therapeutic approach designed to improve emotion regulation will reduce paranoia in people with psychosis. This novel experimental approach to understanding the causes of psychosis will employ 'real-time' experience sampling to examine the effects of the intervention and the relationship between emotion regulation improvements and paranoia.

Woodrow, Karatzias, Harper, Fleming & Hutton (ongoing)

  • This large study of the general population (Target N = 400) seeks to identify the key psychological and emotional mediators of the trauma-psychosis association. The first stage (N=200) will involve exploratory factor analysis, and the second (N=200) will involve confirmatory factor analysis of the previously observed model.

  • The first stage of data collection is nearly complete, and the exploratory analysis is due to commence soon.

  • The website for the study is available here.

Woodrow, Karatzias, Harper, Fleming & Hutton (ongoing)

  • This systematic review is synthesising the existing literature on the psychological and emotional mediators of the trauma-psychosis relationship, taking into account study quality and strength of evidence for causality.

  • Searches, quality assessment and initial syntheses have been completed.

  • The protocol for this review is registered here.

We have also been developing the psychological skills of mental health workers, and researching barriers to the implementation of psychological approaches.

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