Comparing experiential acceptance and cognitive reappraisal as predictors of functional outcome in individuals with serious mental illness

• We know little about psychological regulation in response to psychotic symptoms in natural/non-laboratory settings.
• Experiential acceptance had strong associations with functional outcome in response to psychotic and stressful events.
• Cognitive reappraisal had weak or no associations with functional outcome in response to psychotic and stressful events.
• Further research is needed to confirm these results and to inform treatment development efforts.

BackgroundTwo psychological regulation strategies to cope with psychotic symptoms proposed by the cognitive behavioral tradition were examined in this study: cognitive reappraisal and experiential acceptance. Although cognitive behavior therapy for psychosis has increasing empirical support, little is known about the role of these two strategies using methods of known ecological validity.MethodsIntensive longitudinal data was gathered from 25 individuals diagnosed with a psychiatric disorder with psychotic features. During the course of six days we measured contextual factors, psychotic and stressful events, psychological regulation strategies and functional outcome.ResultsPositive psychotic symptoms and stressful events had negative associations with quality of life and affect, whereas experiential acceptance had positive associations with them. Cognitive reappraisal had inconsistent associations with quality of life and no association with affect. Social interactions and engagement in activities had a positive association with quality of life. Results were supported by additional and exploratory analyses.ConclusionsAcross measures of functional outcome, experiential acceptance appears to be an effective coping strategy for individuals facing psychotic and stressful experiences, whereas cognitive reappraisal does not. In order to inform treatment development efforts, results suggest the need to further investigate the role of these psychological regulation strategies using ecologically valid methods.