Cognitive deficits and emotion regulation strategies in patients with psychogenic nonepileptic seizures: A task-switching study

• We report switching deficits in patients with PNES.
• Their attention is biased towards emotion feature among faces.
• Switching deficits are positively correlated with emotion suppression.
• Switching deficits are negatively correlated with cognitive reappraisal.

This study examined the task-switching ability and emotion regulation strategies in 72 patients with psychogenic nonepileptic seizures (PNES) and 72 healthy individuals, where participants categorized emotion and age dimensions among faces. Results demonstrated cognitive impairment in terms of the interrupted ability to switch between emotion and nonemotion face categorizations in patients with PNES. In contrast, healthy individuals exhibited efficient switching between these face categorizations. In patients with PNES, there was an asymmetric relationship between emotion and age tasks, while this asymmetry was absent in the healthy group. The results demonstrated that patients with PNES used expressive suppression to regulate their emotions more frequently than the control group. On the other hand, patients with PNES less frequently reappraised their cognitions than healthy individuals. Switching deficits in patients with PNES were positively correlated with expressive suppression but were negatively correlated with cognitive reappraisal. This is the first study demonstrating the presence of switching deficits in terms of inferior cognitive control of emotion in patients with PNES as compared to healthy individuals. The switching deficits are associated with emotion regulation strategies. These findings suggest that emotion regulation strategies are significant markers of switching deficits in patients with PNES.