Childhood trauma, managing emotions and psychosis: do specific emotion regulation difficulties mediate the relationship between childhood trauma and psychotic symptoms?

Background Emotional processes contribute to the relationship between childhood trauma and psychosis, but the mechanisms involved are unclear. Since childhood trauma can powerfully affect how individuals learn to understand, relate, and respond to emotions (emotion regulation), emotion regulation difficulties may play a role.Methods In a sample of people with psychosis (n = 47), we used a cross-sectional design and structural equation modelling to examine whether, and which, emotion regulation difficulties mediate the relationship between specific types of childhood trauma (emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect) and psychotic symptoms (persecutory beliefs, commentating voices, conversing voices).Results Difficulties in accessing effective emotion regulation strategies when upset were significantly associated with emotional and physical neglect and mediated the relationship between childhood emotional neglect and commenting voices. No relationships were identified between trauma, emotion regulation difficulties, and conversing voices and persecutory beliefs.Discussion Difficulties applying emotion regulation strategies when distressed may contribute to the relationship between childhood trauma and psychosis and could be a therapeutic target.