Cognitive reappraisal improves the social decision-making performance of suicide attempters

Abstract

A growing body of evidence suggests that emotion regulation (ER) plays a crucial role in the decision-making (DM) process of suicide attempters (SA). Cognitive reappraisal (CR), an emotion regulation strategy that reinterprets emotional situations to alter physiological and emotional responses, has been studied widely. Whereas, its effect on SA is yet to be explored. The present study attempted to use CR to modulate ER in SA to improve their DM performance, and explore the physiological mechanisms underlying this process. Scale scores under natural responses and after using the CR strategy, as well as behavioral and electroencephalographic (EEG) data from subjects were recorded during the classical DM task - ultimatum game (UG) paradigm. 52 patients with psychiatric disorders (including 26 SA and 26 non-suicide attempters) and 22 healthy controls (HC) performed in UG. Scale results showed that negative emotional experience scores decreased in all three groups after CR, but SA showed less improvement compared to HC. The behavioral results showed that acceptance of SA significantly increased after CR in both fair and unfair alternatives in the UG task, suggesting that CR can improve DM performance of SA. Besides, we extracted the late-positive potential (LPP) and theta-gamma coupling (TGC) of EEG for analysis. The LPP of SA was significantly higher when facing unfair alternatives than in fair ones, reflecting the fact that SA showed stronger negative emotions in the face of unfair situations. In addition, SA exhibited TGC diminished in frontotemporal regions when facing unfair allocation schemes, which demonstrated the existence of cognitive impairment in SA. This study verified the feasibility of CR for the moderation of DM ability in SA and provided new ideas for early intervention of suicidal behavior.

Keywords: Cognitive reappraisal; Decision-making; Late-positive potential; Suicide attempters; Theta-gamma coupling; Ultimatum game.

Graphical abstract

Fig. 1

Experimental flow chart.

Fig. 2

(a) Illustration of the UG. (b) CR Strategies Training Materials: “The Crying Woman”. (c) Schematic diagram of the steps for calculating the MI) for PAC.

Fig. 3

Acceptance rates of different allocation schemes for three groups of subjects under NR condition and after use of the CR strategy (Natural condition UG: NUG, Cognitive reappraisal UG: CUG). *p < 0.05, ^⁎⁎p < 0 .01.

Fig. 4

(a) Results of within-group differences in LPP amplitude under NR and after CR conditions for three groups facing different allocation options (Fair option: F, Unfair option: U, Cognitive reappraisal: C, Natural condition: N). (b) Results of within-group differences in LPP amplitude between the three groups in the NR condition and CR condition in the face of different allocation options. *p < 0.05.

Fig. 5

Results of intergroup differences in LPP amplitudes among the three groups under different allocation schemes under NR and after CR conditions. *p < 0.05.

Fig. 6

(a) Results of theta-gamma PAC coupling differences between the three groups under NR and after the CR conditions. (b) Results of the differences in TGC after CR strategies among the three groups. (c) Statistical results of differences in TGC after CR strategies in three groups.