Perceived emotional intelligence is impaired and associated with poor community functioning in schizophrenia and bipolar disorder
Introduction
Research from an affective science perspective has begun to specify differences and similarities in the emotion processing abnormalities associated with schizophrenia and bipolar disorder. On one hand, these disorders are associated with different patterns of in-the-moment responses to emotionally evocative stimuli. While schizophrenia patients demonstrate normal emotional responses to evocative stimuli (Kring and Elis, 2013), bipolar patients demonstrate prolonged positive emotion during emotion-eliciting laboratory tasks (Gruber, 2011). However, both clinical groups show deficits in emotion regulation, including difficulty modulating neural responses to unpleasant stimuli through cognitive reappraisal in schizophrenia (Horan et al., 2013) and, in bipolar disorder, using more emotion regulation strategies, but with less success, than healthy people (Gruber et al., 2012). Examining other aspects of emotion processing can further illuminate differences and similarities across these disorders. For example, an aspect of emotion processing that has received research attention in major mental illness is emotional intelligence (EI). Mayer et al. (2008) define EI as the capacity to process one's own and others' emotions (i.e. perceive, access, generate, and reflectively regulate emotions) to guide thinking about behavior. Accordingly, EI is viewed as a unique set of abilities that plays a critical role in adaptive socio-emotional functioning.
To date, nearly all research on EI in mental illness has focused on performance-based measures, particularly the Mayer–Salovey–Caruso Emotional Intelligence Test (MSCEIT; Mayer et al., 2002). The MSCEIT assesses four “branches” of EI: emotion perception, using emotions, understanding, and managing emotions. Patients with schizophrenia demonstrate impairments on this measure across all four domains, and lower MSCEIT scores are related to greater positive and negative symptoms, low functional capacity, and poor functional outcome (Kee et al., 2009, Eack et al., 2010, Lin et al., 2012). We are aware of only two studies that used the MSCEIT in bipolar disorder and both found that performance was normal (Burdick et al., 2011, Lee et al., 2013).
In addition to performance-based measures, affective scientists have assessed self-reported or “perceived EI.” While the MSCEIT measures one's ability to identify and understand emotions in oneself and others, perceived EI measures the meta-experience of emotion, or one's subjective beliefs about his or her emotional abilities. The most commonly-used measure of perceived EI is the Trait-Meta Mood Scale (TMMS; Salovey et al., 1995). It contains three subscales: (1) Attention to Feelings (Attention): the tendency to notice and value emotions; (2) Clarity of Feelings (Clarity): the tendency to experience and name feelings clearly; and (3) Mood Repair (Repair): one's belief in his or her ability to repair negative emotions by fostering positive feelings. In healthy samples, TMMS scores are not strongly related to performance-based measures, such as the MSCEIT (Mayer et al., 2004), yet both are associated with mental and physical health and better social functioning (Schutte et al., 2007). Studies have demonstrated incremental validity for TMMS for outcomes; in healthy individuals, the TMMS predicts subjective well-being and adaptive functioning above and beyond factors such as current mood state, personality traits, and general intelligence (Palmer et al., 2002, Extremera and Fernández-Berrocal, 2005, Fernandez Berrocal and Extremera, 2008).
Higher scores on Clarity and Repair are consistently associated with positive outcomes, such as greater life satisfaction, interpersonal satisfaction, and less social anxiety and depression (Palmer et al., 2002, Salovey et al., 2002, Salguero et al., 2012). Higher scores on the third subscale, Attention, are sometimes associated with positive outcomes, such as empathy, self-esteem, and adaptive physiological responses to acute stress (Salovey et al., 2002), but have also been associated with greater anxiety and depression (Salovey et al., 1995, Salguero et al., 2012).
We are unaware of any studies of perceived EI in schizophrenia or bipolar disorder using the TMMS. Research has been conducted on concepts related to perceived EI, such as mindfulness and alexithymia (related to the Attention and Clarity subscales) and emotion regulation (related to Repair). Schizophrenia patients display low levels of dispositional mindfulness (Chadwick et al., 2008), while bipolar patients and healthy controls do not differ on mindfulness (Perich et al., 2011). Also, schizophrenia patients report increased alexithymia (van't Wout et al., 2007), which has been associated with increased positive (Serper and Berenbaum, 2008) and negative symptoms (van't Wout et al., 2007). Individuals with schizophrenia additionally report abnormal emotion regulation styles and show impairment on performance-based and neurophysiological tasks (Kee et al., 2009, Kimhy et al., 2012, Horan et al., 2013). Although individuals with bipolar disorder also report abnormal emotion regulation styles (Gruber et al., 2012, Wolkenstein et al., 2014), they do not consistently show impairments on performance-based assessments (Burdick et al., 2011, Lee et al., 2013, Gruber et al., 2014).
There were three objectives for the current study. The first was to compare levels of perceived EI across schizophrenia, bipolar, and control participants. Based on prior research, we expected schizophrenia patients to report lower scores on all TMMS subscales, but we did not have clear directional predictions for the bipolar group. The second objective was to examine the correlations among perceived EI, characteristic symptoms for the two disorders (positive and negative symptoms, mania, and depression), and community functioning within each clinical group. The third objective was to determine whether perceived EI accounted for unique variance in functional outcome for each clinical group, above and beyond any contribution of symptoms.
Section snippets
Participants
Participants were 73 outpatients with schizophrenia (n = 35) or bipolar disorder (n = 38) and 35 healthy control subjects. Patients were recruited from outpatient clinics at University of California, Los Angeles (UCLA), the Veterans Affairs Greater Los Angeles Healthcare System (VAGLAHS), and from local clinics and board and care facilities. Patients met criteria for schizophrenia or bipolar I disorder based on the Structured Clinical Interview for DSM-IV (SCID) Axis I Disorders (First et al., 1996
Demographics, symptoms, and functioning
The three groups did not differ on sex, age, race, ethnicity, or parental education (Table 1). There were group differences on personal education; schizophrenia patients had lower education levels compared to bipolar and control participants.
On the CAINS, schizophrenia patients demonstrated higher MAP and EXP negative symptoms than the other two groups. Bipolar patients also demonstrated higher MAP symptoms compared to controls, though these groups did not differ on EXP symptoms. In addition,
Discussion
In this study, schizophrenia patients reported lower perceived EI than healthy controls across all TMMS subscales. Bipolar patients also reported lower Clarity, Repair, and Total perceived EI compared to healthy controls, and the two clinical groups did not significantly differ on any TMMS subscales. Perceived EI showed significant relationships to different clinical symptoms and aspects of functioning within each clinical group, and correlations were robust between TMMS, manic symptoms, and
Role of funding source
Funding for the current study was provided by NIMH Grants MH091468 (William P. Horan, Ph.D.) and MH065707 and MH43292 (Michael F. Green, PhD).
Contributors
All authors contributed to the conceptualization of the study. Statistical analyses and writing of the first draft of the manuscript were performed by Dr. Tabak. Dr. Horan assisted with the literature review and statistical analyses. All authors contributed to and have approved the final manuscript.
Conflict of interest
Dr. Green reports consulting for AbbVie, DSP, Forum, Mnemosyne (scientific board), and Roche. He has received research support from Amgen. The rest of the authors report no biomedical financial interests or potential conflicts of interest.
Acknowledgments
Support for this study came from NIMH Grants MH091468 (William P. Horan, Ph.D.) and MH065707 and MH43292 (Michael F. Green, PhD). A postdoctoral fellowship for the first author was supported by an NIMH training grant in Cognitive and Affective Dysfunctions in the Psychoses at the University of California, Los Angeles (T32MH09668). The authors wish to thank Amanda Bender, Michelle Dolinsky, Crystal Gibson, Cory Tripp, and Katherine Weiner for assistance in data collection.
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