Emotion Regulation in Schizophrenia: Affective, Social, and ClinicalCorrelates of Suppression and Reappraisal

Julie D. HenryUniversity of New South Wales

Peter G. RendellAustralian Catholic University

Melissa J. GreenUniversity of New South Wales and Black Dog Institute

Skye McDonaldUniversity of New South Wales

Maryanne O’DonnellKiloh Centre, Prince of Wales Hospital

Individuals can exert considerable control over their experience and expression of emotion by applyingdifferent regulatory strategies such as reappraisal and suppression. However, although it has beensuggested that blunted affect in schizophrenia, characterized by markedly reduced emotion expressivityalongside apparently normal emotion experience, may reflect overuse of suppression, no study to date hasassessed self-reported use of these different emotion regulatory strategies in relation to this disorder. Inthe present study, 41 individuals with schizophrenia and 38 control participants completed a self-reportmeasure that differentiated between use of suppression and reappraisal. Symptom severity and variousaspects of cognitive and psychosocial functioning were also assessed. Relative to controls, individualswith schizophrenia did not differ with regard to their reported use of suppression and reappraisal, andreported use of both strategies was unrelated to clinical ratings of blunted affect. However, whereas(lower) use of reappraisal was associated with greater social function impairment for both groups, onlyfor controls was (greater) use of suppression associated with reduced social functioning. Implications forunderstanding blunted affect and social dysfunction in schizophrenia are discussed.

Keywords: schizophrenia, emotion regulation, suppression, reappraisal, blunted affect

One of the most prominent emotion abnormalities associatedwith schizophrenia is blunted affect, characterized by markedlyreduced emotion expressivity, alongside apparently normal emo-tion experience (Berenbaum & Oltmanns, 1992). This clinicalfeature is predictive of poor prognosis and has been particularlylinked to the social behavioral abnormalities associated with thedisorder (Dworkin, Oster, Clark, & White, 1998). It has beensuggested that this disjunction between the experience and expres-sion of affect may reflect a specific deficit up-regulating emotion-expressive behavior (Kring & Werner, 2004). Consistent with this

proposal, using an experimental methodology in which the regu-latory demands of the emotional task were directly manipulated,Henry et al. (2007) showed that individuals with schizophreniademonstrate significant deficits in the behavioral augmentation ofan already initiated emotion, or amplification of emotion-expressive behavior. This suggests that individuals with schizo-phrenia may not have the capacity to express a level of emotionthat is commensurate with their subjective experience. Further,deficits in this capacity are significantly correlated with clinicallevels of blunted affect (Henry et al., 2007).

However, in their model of emotion dysregulation, Kring andWerner (2004) note that dysregulation may involve not only adeficiency in regulatory processes, but also maladaptive use ofotherwise intact processes. In the case of schizophrenia, it has beensuggested that blunted affect may reflect overuse of suppression(i.e., the conscious inhibition of ongoing emotion-expressive be-havior) as an emotion regulatory strategy (Ellgring & Smith,1998). Indeed, whereas Henry et al. (2007) found that individualswith schizophrenia were selectively impaired in their ability toamplify emotion-expressive behavior, no deficits were observed inthe ability to suppress ongoing emotion-expressive behavior. Thus,blunted affect in schizophrenia might reflect not only difficultieswith amplification of emotion-expressive behavior, but also over-use of the intact regulatory process of suppression. However, nostudy to date has directly tested whether individuals with schizo-

Julie D. Henry and Skye McDonald, School of Psychology, Universityof New South Wales, Sydney, Australia; Peter G. Rendell, School ofPsychology, Australian Catholic University, Melbourne, Australia; MelissaJ. Green, School of Psychiatry, University of New South Wales and BlackDog Institute, Prince of Wales Hospital, Sydney, Australia; MaryanneO’Donnell, Kiloh Centre, Prince of Wales Hospital, Sydney, Australia.

This research was supported by Grant DP0663182 awarded to Julie D.Henry and Skye McDonald by the Australian Research Council. Weacknowledge the Research Register of the Schizophrenia Research Insti-tute, Australia, for assisting with the recruitment of the volunteers partic-ipating in this research, as well as the participants themselves.

Correspondence concerning this article should be addressed to Julie D.Henry, School of Psychology, University of New South Wales, Sydney2052 Australia. E-mail: julie.henry@unsw.edu.au

Journal of Abnormal Psychology Copyright 2008 by the American Psychological Association2008, Vol. 117, No. 2, 473–478 0021-843X/08/$12.00 DOI: 10.1037/0021-843X.117.2.473

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phrenia differ from nonclinical volunteers with regard to theirhabitual use of suppression in day-to-day life.

It is also informative to assess use of antecedent-focused regu-latory strategies in the context of schizophrenia. Whereasresponse-focused emotion regulatory strategies such as suppres-sion and amplification occur after the emotion response has beentriggered and require management of the ongoing emotional ex-pression and physiological response, antecedent-focused strategiesare applied earlier in the emotion-generation process and thusinfluence not only what is expressed behaviorally but also what isexperienced subjectively. A typical example of this type of strat-egy is reappraisal of the emotion-eliciting situation (i.e., cognitivetransformation of the stimulus in order to alter its emotionalsignificance).

Individuals differ systematically in their use of reappraisal andsuppression, and, whereas habitual use of the former is associatedwith increased positive affect and improved interpersonal func-tioning, habitual use of suppression is associated with increasednegative affect and impaired interpersonal functioning (Butler etal., 2003; John & Gross, 2007). This has been attributed to the factthat response-focused strategies produce an incongruence betweenthe emotion experienced and the emotion expressed, leading to asense of “inauthenticity” and to less effective mood repair. Withantecedent-focused strategies no such discrepancy is experienced.Additionally, facial expressions and other nonverbal emotion-expressive behaviors serve a critical role as indicators of emotionsin social situations, and thus any discrepancy between the emotionexperienced and the emotion expressed has the potential to causecommunicative misunderstandings during social interactions(Aghevli, Blanchard, & Horan, 2003; Troisi, Pompili, Binello, &Sterpone, 2007). Research involving nonclinical volunteers hasshown that, relative to nonsuppressors, suppressing individualsrespond less naturally and appropriately in social situations; appearavoidant; and have difficulties engaging socially, communicatingeffectively, as well as establishing and maintaining rapport (Butleret al., 2003; John & Gross, 2004).

The aim of the present study was to assess whether individualswith schizophrenia differ from controls with respect to their re-ported use of suppression and reappraisal as regulatory strategies,as well as whether use of these different regulatory strategies (andin particular suppression) is associated with blunted affect. Addi-tionally, we assessed whether for individuals with schizophreniareported use of suppression and reappraisal relate differentially toaffective well-being and social functioning, as has been shown tobe the case in studies involving nonclinical research participants.

Method

Participants

Forty-one clinical participants (36 outpatients, 5 inpatients)were recruited from outpatient and rehabilitation clinics in Sydney,Australia. Diagnoses of schizophrenia (n � 32) or schizoaffectivedisorder (n � 9) were made by treating psychiatrists according tothe Diagnostic and Statistical Manual of Mental Disorders (4thed.; American Psychiatric Association, 2004). Inpatients wereclients attending a rehabilitation unit who were identified by thetreating psychiatrist as being in a stable phase of illness. For allparticipants, a current major depressive or manic episode was one

of the exclusionary criteria applied. No significant differenceswere observed between schizoaffective or schizophrenia partici-pants, or inpatients or outpatients, on any of the demographic orclinical variables of interest. All participants were over 18 years ofage, in a stable phase of illness, and receiving atypical antipsy-chotic medication (in terms of chlorpromazine equivalents, M �357.6, SD � 234.75).1 The average age of onset was 22.6 years(SD � 5.23) and the average duration of illness was 14.6 years(SD � 10.50). As assessed by the Scale for the Assessment ofPositive Symptoms (SAPS; Andreasen, 1983b) and the Scale forthe Assessment of Negative Symptoms (SANS; Andreasen, 1983a),respectively, the mean SAPS score was 5.5 (SD � 4.09), and themean SANS score was 7.3 (SD � 3.93).

Thirty-eight control participants were recruited via advertise-ments placed in newspapers. All control participants were inter-viewed via telephone prior to inclusion to ensure that they had nopersonal history of psychopathology. Participants in the twogroups did not differ in age (M � 37.5 years, SD � 10.67, andM � 36.1 years, SD � 11.99, respectively), t(77) � 0.54, p � .59;education (M � 13.1 years, SD � 2.65, and M � 13.9 years, SD �2.28, respectively), t(77) � 1.32, p � .19); or gender (46% vs.55% males in the schizophrenia and control groups, respectively),�2(1, N � 79) � 0.63, p � .428. Exclusion criteria for allparticipants were an identifiable neurological disorder, severe al-cohol/drug abuse as indexed by self-reported regular use of illicitsubstances, or regularly drinking to intoxication.

Current Intelligence, Premorbid Intelligence, and Mood

Wechsler’s Abbreviated Scale of Intelligence (WASI; Wechsler,1999) was used to quantify current intelligence. The four subtests(Vocabulary, Block Design, Similarities, and Matrix Reasoning),which are included, have the highest loadings of all WechslerAdult Intelligence Scale subscales on general intellectual function-ing. The age-standardized score based on performance on thesesubscales was calculated. To obtain an index of premorbid intel-ligence, we derived estimates of Full Scale IQ on the basis of thenumber of errors made on the National Adult Reading Test(NART; Nelson, 1991). The NART provides reliable, valid esti-mates of premorbid Wechsler Full Scale IQ in schizophrenia(Russell et al., 2000).

The Hospital Anxiety and Depression Scale (HADS; Zigmond& Snaith, 1983) was used to establish levels of anxiety anddepression. The HADS is a 14-item self-report measure, frequentlyused in clinical practice and research, and reported to demonstrategood internal consistency and test-retest reliability (Crawford,Henry, Crombie, & Taylor, 2001). For the schizophrenia group,estimates of Cronbach’s alpha were .82 and .66, respectively, forthe Anxiety and Depression subscales; for the control group, thecorresponding values were .69 and .62, respectively.

Emotion Regulation

The Emotion Regulation Questionnaire (ERQ; Gross & John,2003) consists of 10 questions, 4 of which focus upon suppression

1 Atlhough this conversion is controversial as applied to atypical anti-psychotics, it is nevertheless useful for assessing broad trends acrosspatient groups. For details on the conversion procedure used, see Henry etal. (2007).

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(e.g., “I keep my emotions to myself”) and 6 of which focus oncognitive reappraisal (e.g., “When I want to feel more positiveemotion . . . I change what I’m thinking about”). On the ERQ, useof each emotion regulation strategy was rated from 1 (stronglydisagree, indicating that the strategy is not frequently used) to 7(strongly agree, indicating that the strategy is frequently used).The ERQ has acceptable reliability and has been shown to haveconsiderable validity as an index of the constructs it was developedto assess (Gross & John, 2003). In the present study, for theschizophrenia participants, alpha � .67 and .72 for the Suppressionand Reappraisal scales, respectively; for the control participants,alpha � .63 and .86, respectively.

Social Functioning

The Social Functioning Scale (SFS; Birchwood, Smith, Co-chrane, Wetton, & Copestake, 1990) is a 79-item questionnairethat assesses seven domains of social behavior: Social Engage-ment/Withdrawal, Interpersonal Communication, Independence-Performance, Independence-Competence, Recreation, ProsocialBehavior, and Employment/Occupation. Scores on all domainswith the exception of Employment/Occupation were pooled. Thissubscale was omitted because of poor correlations with the othersubscales, particularly for the control group for whom ceilingeffects in responding were observed. The SFS has been found todemonstrate adequate reliability, sensitivity, and construct validityin patients with schizophrenia and nonpsychiatric control partici-pants (Birchwood et al., 1990). In the present study, Cronbach’salpha based on the six subscales was estimated to be .70 for theparticipants with schizophrenia and .62 for control participants.

Results

Details related to participants’ current and premorbid intelli-gence as well as psychosocial functioning are provided in Table 1.In addition to descriptive and inferential statistics, effect sizes ofgroup differences expressed as Cohen’s d are reported; Cohen(1988) defined effect sizes of 0.2 as small, 0.5 as medium, and 0.8

as large. It can be seen that although the two groups did not differwith regard to premorbid intelligence, participants with schizo-phrenia were impaired on the WASI and reported higher levels ofdepression, anxiety, and reduced social functioning.

Use of Particular Emotion Regulatory Strategies

ERQ data are also provided in Table 1, and it can be seen thatindividuals with schizophrenia did not differ from control partic-ipants with regard to their reported use of suppression and reap-praisal as regulatory strategies. In nonclinical American cohorts,means for suppression scores have been reported to range from 3.0to 3.6 and for reappraisal from 4.6 to 5.0 (Gross & John, 2003;Matsumoto, 2006). The mean scores for both the control and theschizophrenia groups are therefore within this previously reportedrange.

It is of note that three ERQ items refer to regulation of positiveemotions, four to regulation of negative emotions, and three toregulation of nonvalenced emotional states. To address whetheruse of suppression or reappraisal differs for individuals withschizophrenia relative to control participants as a function of thevalence of the emotional state, exploratory analyses were con-ducted. No group differences were observed across these threeclasses of emotional valence: t(77) � 0.06, p � .955; t(77) � 0.39,p � .700; and t(77) � 0.11, p � .911, respectively.

Associations With Affect, Social Functioning, andPsychopathology

Correlations between use of suppression and reappraisal withnegative affect, social functioning, chlorpromazine equivalents(CPZe), as well as psychopathology ratings are reported in Table2. For both individuals with schizophrenia and control participants,greater reported use of reappraisal was significantly associatedwith better social functioning (rs � .34 and .38, respectively).Further, for participants with schizophrenia, greater use of reap-praisal as a regulatory strategy was significantly associated with

Table 1Cognitive and Psychosocial Characteristics of Participants With Schizophrenia (SCZ) and Controls

Measure

SCZ group Control group Inferential statistics

Cohen’s dM SD M SD t df p

Current intelligenceWASI 91.9 14.79 106.1 10.54 4.87 77 �.001 1.11

Premorbid intelligenceNART 99.9 11.78 103.5 11.63 1.36 77 .179 0.31

Negative affectHADS Depression 6.8 3.43 3.6 2.18 4.87 77 �.001 1.11HADS Anxiety 9.0 4.49 6.1 2.76 3.50 77 �.001 0.80

Social functioningSFS 116.8 20.08 150.4 17.09 7.97 77 �.001 1.82

Emotion regulationSuppression 3.5 1.22 3.3 1.14 1.03 77 .308 0.24Reappraisal 4.8 1.14 5.0 1.25 0.82 77 .415 0.19

Note. WASI � Wechsler Abbreviated Scale of Intelligence; NART � National Adult Reading Test; HADS � Hospital Anxiety and Depression Scale;SFS � Social Functioning Scale. WASI scores are presented as age-standardized scores (with M � 100 and SD � 15). For the NART, predicted WAISFull Scale IQ scores are presented (with M � 100, and SD � 15) to provide an estimate of premorbid IQ (see Nelson, 1991).

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lower depression (r � �.37). For participants with schizophrenia,neither suppression nor reappraisal were significantly correlatedwith CPZe or any of the SANS or SAPS subscales, although it isof note that greater use of suppression was generally positivelyassociated, and greater use of reappraisal was generally negativelyassociated, with psychopathology ratings. However, of particularinterest was the finding that blunted affect was not significantlyrelated to use of suppression (r � .18). Further, for control par-ticipants (but not for individuals with schizophrenia), greater useof suppression was associated with significantly reduced socialfunctioning and increased depression.

Discussion

The present findings show that individuals with schizophreniado not differ from control participants with regard to their self-reported use of suppression and reappraisal as methods of regu-lating emotion experience and expression. These data may beregarded as counterintuitive given that schizophrenia is associatedwith high trait negative affectivity (Horan & Blanchard, 2003),which is associated with emotion dysregulation (John & Gross,2007). Indeed, there is a considerable literature focused on therelated construct of maladaptive coping, with schizophrenia typi-cally shown to be associated with reduced use of adaptive, andincreased use of maladaptive, coping strategies (Horan & Blan-chard, 2003; Meyer, 2001). It might therefore be argued that thefailure to identify group differences in use of reappraisal or sup-pression reflects either specific sample characteristics or a uniquefeature of the scale used to operationalize these constructs in thepresent study.

It is not possible to rule out either of these possibilities. Indeed,the items on the measure of emotion regulation may be regarded asrelatively abstract and general, and thus it may be difficult forpatients to understand these items or to relate them to experiencesthat occur in their daily lives, a difficulty that may be compoundedgiven issues related to insight in this population. However, it hasbeen shown that schizophrenia patients approach and completeself-report scales of emotion in the same ways as nonpatientcontrol participants. Kring, Feldman Barrett, and Gard (2003), forinstance, found that when self-report methodology is used, thesame two-dimensional valence-arousal pattern emerged for indi-viduals with schizophrenia and for nonpatient control participants.Further, it is encouraging that the pattern of correlations observedbetween reappraisal and well-being in both the schizophrenia andcontrol groups in the present study were entirely congruent withprior empirical research and theory (John & Gross, 2004, 2007),suggesting that individuals with schizophrenia were able to under-stand the items and accurately self-report their use of differentemotion regulation strategies.

Mechanisms Underpinning Blunted Affect inSchizophrenia

The lack of difference between groups with respect to use ofsuppression is of particular interest given that it has previouslybeen hypothesized that blunted affect may reflect overuse ofsuppression (Ellgring & Smith, 1998). Coupled with the failure toidentify any association between use of suppression and clinicalratings of blunted affect, this finding suggests that blunted affectdoes not reflect maladaptive use of this regulatory strategy. As

Table 2Correlations Between Suppression and Reappraisal With Measures of Negative Affect, SocialFunctioning, Chlorpromazine Equivalents (CPZe), and Psychopathology

Measure

SCZ group Control group

Suppression Reappraisal Suppression Reappraisal

Negative affectHADS Depression .12 �.37* .32* �.23HADS Anxiety .17 �.04 .21 �.26

Social functioningSFS �.13 .38* �.34* .34*

MedicationCPZe �.02 �.09 — —

SAPS subscalesHallucinations .03 �.10 — —Delusions .20 �.06 — —Bizarre Behavior .03 �.12 — —Thought Disorder .03 .07 — —

SANS subscalesBlunted Affect .18 �.21 — —Alogia .14 �.11 — —Apathy .30 �.07 — —Anhedonia .08 �.24 — —Attention .25 �.28 — —

Note. SCZ � schizophrenia; HADS � Hospital Anxiety and Depression Scale; SFS � Social Functioning Scale;SAPS � Scale for the Assessment of Positive Symptoms; SANS � Scale for the Assessment of NegativeSymptoms; dash � data not applicable.*p � .05.

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noted previously, Henry et al. (2007) found that whereas bothindividuals with schizophrenia and control participants were ableto effectively implement the strategy of suppression, only controlparticipants were able to exaggerate their behavioral responseduring an experimental condition in which they were instructed toshow their feelings as much as possible. Further, behavioral ex-pression in the amplification condition was significantly correlatedwith degree of emotional blunting. On the basis of these findings,Henry et al. (2007) suggested that the disjunction between theexperience and expression of affect associated with schizophreniamay reflect a specific deficit up-regulating emotion-expressivebehavior (i.e., generating an affective response that is commensu-rate with affective experience). As Kring and Werner (2004) note,“An inability to do so would suggest a problem in emotion regu-lation insofar as matching expression with experience is construedas a form of response-focused emotion regulation” (p. 373).

However, it is also important to note that human nonverbalbehaviors are not just “readouts” of emotional states but ratherrepresent an important means of social communication. There isconsiderable evidence that individuals with schizophrenia presentwith marked social skills impairment and that these deficits areparticularly related to negative symptom presentation (Glynn,1998). Further, these deficits are not confined to any specific focalareas of social skill but encompass many component skills (e.g.,nonverbal skills such as eye contact and body orientation, as wellas paralinguistic elements, verbal content, and interactive balance)and exhibit temporal stability (Mueser & Bellack, 1998). Thus, itseems likely that blunted affect may not only reflect difficultieswith aspects of emotional responding such as amplification, butalso more with fundamental deficits in social communicationskills.

Correlates of Suppression and Reappraisal

For both patients with schizophrenia and control participants,greater use of reappraisal was associated with fewer social func-tion difficulties, whereas for the schizophrenia group increased useof reappraisal was also associated with significantly reduced de-pression. These data are consistent with other individual differencestudies demonstrating that use of reappraisal is associated withimproved interpersonal functioning and affective well-being (John& Gross, 2004) but are the first to show that these relationshipsextend to individuals with schizophrenia. Importantly, reappraisaloccurs during the early appraisal phase of emotion generation andthus serves to influence not only behavioral expression (as is thecase for suppression), but also affective experience. This maytherefore explain why for individuals with schizophrenia greaterreported use of reappraisal (but not suppression) was associatedwith reduced depression. In nonclinical volunteers, positive asso-ciations between social outcomes and use of reappraisal havepreviously been attributed to the greater experience and expressionof positive emotions, reduced experience and expression of nega-tive emotions, as well as the more generally positive take onchallenging situations associated with use of this regulatory strat-egy. It seems likely that similar mechanisms may be responsiblefor the association between reappraisal and social functioningobserved for schizophrenia participants in the present study.

However, for the schizophrenia group, self-reported use of sup-pression was not significantly associated with any of the indices of

psychosocial functioning. These results run contrary to a consid-erable literature showing that habitual use of suppression is asso-ciated with negative implications for mental health and interper-sonal functioning (Butler et al., 2003; John & Gross, 2004, 2007),and indeed, in the present study greater reported use of thisregulatory strategy in the control group was associated with higherlevels of depression and increased social function difficulties.

As noted previously, habitual use of suppression is regarded asan “unhealthy” form of emotion regulation because it is appliedlate in the emotion-generative process and therefore involves ef-fortful management of emotion response tendencies as they con-tinually arise (John & Gross, 2004). Indeed, although use ofreappraisal imposes substantial demands on cognitive mechanismsprior to an emotional experience, and in particular, higher orderaspects of cognitive control such as mental flexibility and workingmemory in order to look at events from different perspectives andhold these different perspectives in mind while assessing theirsignificance, use of reappraisal has been shown to only minimallyimpact ongoing task efficiency. In contrast, use of expressivesuppression may be regarded as “capacity consuming,” associatedwith substantial costs to ongoing task performance (see John &Gross, 2007). Thus, the ongoing cognitive demands of suppressionmay contribute to interpersonal behavior that is strained, dis-tracted, and avoidant.

Accordingly, it is suggested that the capacity consuming natureof expressive suppression may at least partially explain the failureto identify associations between use of this strategy with mentalwell-being and social functioning. As noted, Henry et al. (2007)found that individuals with schizophrenia did not differ fromcontrol participants in their capacity to engage in expressive sup-pression under controlled experimental conditions. However, thisstudy involved suppressive behavior in the context of nonsocialstimuli (i.e., watching a video clip) of limited temporal duration(i.e., participants were asked to suppress expressive behaviors forseveral minutes only). In everyday life, ongoing task demands areliable to be greater, as it may be necessary to engage in expressivesuppression for more extensive periods of time while also produc-ing interpersonal behavior that is appropriately focused on theinteraction partner. Less effective implementation of suppressionregulation strategies in day-to-day life may therefore also at leastpartially explain the failure to identify associations between use ofsuppression, mental well-being, and social functioning.

In conclusion, the present results suggest that blunted affect inthe context of schizophrenia does not reflect maladaptive use ofsuppression. Further, individuals with schizophrenia do not differfrom nonclinical volunteers with regard to their reported use ofreappraisal. However, whereas greater use of reappraisal has anal-ogous (positive) implications with regard to interpersonal func-tioning and affective well-being as has been shown for nonclinicalvolunteers, use of suppression is not associated with the same(negative) repercussions. Nevertheless, future research is neededto further delineate the affective and social consequences of dif-ferent types of emotion regulation in this population. Further, thetypes of regulation strategy habitually used may vary across dif-ferent types of emotions. Although exploratory analyses did notprovide evidence for differential schizophrenia effects with respectto regulation of positive, negative, and nonvalenced emotionalstates, assessment involving more specific emotional states, andparticularly negative emotions such as sadness, anger and fear, is

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needed. Assessment of the strategies used to regulate feelings ofthreat-related emotions (i.e., anger and fear) would be of particularinterest given considerable evidence for heightened sensitivity tothese emotions in the development of persecutory delusions(Green & Phillips, 2004), and in terms of social outcomes, angerappears to be the most important of all negative emotions (Lazarus,1996). These data could then be used to inform the development ofcognitive-behavioral techniques focused on improving emotionregulation in schizophrenia. Indeed, the importance of cognitive-behavioral techniques focused on remediation of social cognitivedifficulties in schizophrenia is now well recognized, and there ispreliminary evidence showing that such interventions may beeffective in helping individuals with schizophrenia manage theirown emotional states (Eack, Hogarty, Greenwald, Hogarty, &Keshavan, 2007).

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Received June 18, 2007Revision received September 25, 2007

Accepted September 25, 2007 �

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