The resistance of negative symptoms to pharmacologic treatment has spurred interest in understanding the psychological factors that contribute to their formation and persistence. However, little is understood about the psychological processes that reinforce and sustain the negative symptoms domain of diminished expression. Prior research has shown that higher levels of diminished expression relate to deficits in metacognitive capacity. We propose a more complex model in which diminished expression occurs when impairments in metacognitive self-reflectivity, alterations in higher-order language structure, and cognitive symptoms interact and thus interfere with persons' ability to understand and express emotions in ways others can recognize. Individuals with schizophrenia-spectrum disorders (N = 201) provided personal narratives detailing their life story and reflections about their mental illness. Self-reflectivity was measured with the Metacognition Assessment Scale-Abbreviated, and situation models were extracted from participants’ personal narratives via Coh-Metrix 3.0, an automated program that calculates language indices. Diminished expression and cognitive symptoms were measured with the Positive and Negative Syndrome Scale. Structural equation models (SEM) examined whether self-reflectivity mediated the impact of cognitive symptoms and situation models on diminished expression. Results of the SEM revealed that self-reflectivity partially mediated the impact of situation models on diminished expression (β = −.073, p = .008, ±95% CI [-0.126, −0.019]). and fully mediated the influence of cognitive symptoms in diminished expression (β = 0.099, p = .001, ±95% CI [0.038, 0.160]). In conclusion, results suggest that self-reflectivity, linguistic cohesion, and cognitive symptoms may be useful targets for intervention in efforts to treat diminished expression in psychosis.

阴性症状对药物治疗的抵抗激发了人们对了解导致其形成和持续存在的心理因素的兴趣。然而，人们对强化和维持表达减少的负面症状领域的心理过程知之甚少。先前的研究表明，较高水平的表达减少与元认知能力的缺陷有关。我们提出了一个更复杂的模型，其中当元认知自我反思受损、高阶语言结构的改变和认知症状相互作用时，就会发生表达减少，从而干扰人们以其他人可以识别的方式理解和表达情绪的能力。精神分裂症谱系障碍患者（N = 201) 提供了详细描述他们的生活故事和对他们精神疾病的反思的个人叙述。使用元认知评估量表 - 缩写测量自我反思，并通过 Coh-Metrix 3.0（一种计算语言指数的自动化程序）从参与者的个人叙述中提取情境模型。减少的表达和认知症状用阳性和阴性综合征量表测量。结构方程模型 (SEM) 检查了自我反思是否介导了认知症状和情境模型对表达减弱的影响。SEM 的结果显示，自我反射在一定程度上调节了情境模型对表达减少的影响（β = -.073，  p= .008, ±95% CI [-0.126, -0.019])。并完全介导认知症状对表达减少的影响（β  = 0.099, p  = .001, ±95% CI [0.038, 0.160]）。总之，结果表明，自我反思、语言凝聚力和认知症状可能是干预治疗精神病表达减少的有用目标。