Social disconnection and psychotic-like experiences in daily life: Unravelling the mediating role of threat anticipation.

BackgroundIncreasingly, evidence points to the involvement of cognitive and affective processes in psychotic disorders. To determine the interplay of mechanisms involved in the development and maintenance of psychosis, these pathways must be studied in different stages of psychosis, such as early psychosis. Previous research, however, mostly uses cross-sectional data, and there remains a need to extend research to include timeseries and longitudinal models to investigate the direction of the relationship between these processes and psychotic experiences.MethodsLagged multilevel moderated mediation models were used to analyze the experience sampling method (ESM) data of 53 controls, 46 participants with at-risk mental state (ARMS) for psychosis, and 51 participants with first-episode psychosis (FEP) to investigate the direction of effect between threat anticipation, negative affect, and psychotic experiences. Furthermore, specific affect symptoms (i.e., anxiety and insecurity, separately) and psychotic experiences (i.e., paranoia and visual and auditory hallucinations, separately) were analyzed.ResultsThe effect of threat anticipation (t0) on psychotic experiences (t1) was mediated by negative affect for ARMS participants and controls. Threat anticipation (t0) had a direct effect on psychotic experiences (t1) and psychotic experiences (t0) had a direct effect on threat anticipation (t1) for FEP participants. The relationship between threat anticipation (t0) and paranoia (t1) was mediated by anxiety for FEP participants and controls and mediated by insecurity for ARMS participants. Threat anticipation (t0) had a direct effect on auditory and visual hallucinations (t1) for FEP participants, and there was a direct effect of visual hallucinations (t0) on threat anticipation (t1) for ARMS participants.DiscussionThe findings demonstrate that threat anticipation leads to psychotic experiences, including paranoia and hallucinations, and affective disturbances mediate some of the relationships. However, there was inadequate evidence for psychotic experiences, paranoia, and hallucinations leading to threat anticipation. Together, these results provide insight into the direction of cognitive and affective processes that develop and maintain psychotic experiences in early psychosis.

While contemporary models of psychosis have proposed a number of putative psychological mechanisms, how these impact on individuals to increase intensity of psychotic experiences in real life, outside the research laboratory, remains unclear. We aimed to investigate whether elevated stress sensitivity, experiences of aberrant novelty and salience, and enhanced anticipation of threat contribute to the development of psychotic experiences in daily life. We used the experience sampling method (ESM) to assess stress, negative affect, aberrant salience, threat anticipation, and psychotic experiences in 51 individuals with first-episode psychosis (FEP), 46 individuals with an at-risk mental state (ARMS) for psychosis, and 53 controls with no personal or family history of psychosis. Linear mixed models were used to account for the multilevel structure of ESM data. In all 3 groups, elevated stress sensitivity, aberrant salience, and enhanced threat anticipation were associated with an increased intensity of psychotic experiences. However, elevated sensitivity to minor stressful events (χ2 = 6.3, P = 0.044), activities (χ2 = 6.7, P = 0.036), and areas (χ2 = 9.4, P = 0.009) and enhanced threat anticipation (χ2 = 9.3, P = 0.009) were associated with more intense psychotic experiences in FEP individuals than controls. Sensitivity to outsider status (χ2 = 5.7, P = 0.058) and aberrantly salient experiences (χ2 = 12.3, P = 0.002) were more strongly associated with psychotic experiences in ARMS individuals than controls. Our findings suggest that stress sensitivity, aberrant salience, and threat anticipation are important psychological processes in the development of psychotic experiences in daily life in the early stages of the disorder.

Individuals with psychosis might show heightened sensitivity to minor daily stressors. However, it is unclear if this sensitivity extends to the broader population with subclinical psychopathology, reflected in psychotic-like experiences (PLEs). This study examined whether individuals with PLEs show increased symptom and cortisol responses to minor daily stressors. Altogether, 99 individuals with PLEs and 102 controls without PLEs were enrolled from the general population (aged 18-35years). Using the experience sampling method over 7days, participants reported PLEs, negative affect, threat anticipation, aberrant salience, and stress across different categories: area-related, activity-related, event-related, and social stress. Saliva samples for cortisol measurement were collected after each prompt. Participants with PLEs demonstrated significantly greater symptom and threat anticipation responses to all stress categories compared to controls. Aberrant salience responses to stress showed sex differences; females with PLEs exhibited stronger aberrant salience responses to most stress categories compared to males, a pattern not observed in controls. Elevated salivary cortisol levels were found among participants with PLEs (Cohen's d = 0.265) regardless of stress exposure, though this effect varied across stress categories in different models. The extended psychosis phenotype might be linked to elevated salivary cortisol and heightened responses to minor stressors in affective symptoms and threat anticipation, supporting the presence of increased stress sensitivity in people with PLEs. The observed sex-specific differences indicate that aberrant salience may play a distinct and nuanced role in stress sensitivity among individuals with PLEs, especially in females.

Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been implicated in the development of psychosis and subthreshold psychotic symptoms commonly referred to as psychotic-like experiences (PLEs). The exact mechanisms linking the HPA axis responses with the emergence of PLEs remain unknown. The present study aimed to explore real-life associations between stress, negative affect, salivary cortisol levels (a proxy of the HPA axis activity) as well as PLEs together with their underlying cognitive biases (i.e., threat anticipation and aberrant salience). The study was based on the experience sampling method scheduled over 7 consecutive days in the sample of 77 drug-naïve, young adults (18-35 years). The saliva samples were collected with each prompt to measure cortisol levels. A temporal network analysis was used to explore the directed associations of tested variables. Altogether, 3234 data entries were analyzed. Data analysis revealed that salivary cortisol levels did not directly predict next-moment fluctuations of PLEs. However, higher salivary cortisol levels were associated with higher next-moment levels of PLEs through the effects on threat anticipation and negative affect. In turn, PLEs appeared to predict cortisol levels through the effects on negative affect and event-related stress. Negative affect and threat anticipation were the most central nodes in the network. There might be bidirectional associations between the HPA axis responses and PLEs. Threat anticipation and negative affect might be the most important mediators of these associations. Interventions targeting these mediators might hold promise for disrupting the connection between the HPA axis dysregulation and PLEs.

Evidence suggests that self-esteem is an important mechanism in pathways to psychosis. However, whether low or high self-esteem is associated with psychotic experiences remains unclear. Besides, a limited number of studies has investigated fluctuations in state self-esteem in psychotic patients. This study investigated cross-sectional and temporal associations of momentary self-esteem and fluctuations in self-esteem with psychotic symptoms in three groups with different levels of (familial) liability to psychotic disorder. Using the Experience Sampling Method (ESM), momentary self-esteem, fluctuations in self-esteem (i.e., variability and instability), and psychotic experiences, paranoia, negative symptoms (i.e., event anhedonia and social anhedonia), intensity of negative affect and altered affective experiences (instability and variability in negative affect) were assessed in 147 psychotic patients, 131 of their siblings and 113 controls. Lower levels of momentary self-esteem were associated with an increased intensity of psychotic experiences, paranoia and negative affect, with the magnitude of the associations for momentary self-esteem being greatest in patients, followed by relatives. Variability in self-esteem was associated with psychotic and paranoid experiences, the magnitudes were greatest in relatives. Furthermore, we found reciprocal effects between momentary self-esteem and psychotic experiences, paranoia, negative affect, and instability in negative affect. These findings suggest that individuals with familial liability to psychosis (patients and their first-degree relatives) might benefit from targeting momentary self-esteem and variability in self-esteem to decrease the intensity of psychotic experiences, paranoia, and negative affect in daily life. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

BackgroundExposure to childhood trauma is associated with an increased risk of developing and maintaining psychotic symptoms later in life. Self-esteem might be an important psychological process underlying the association between childhood trauma and psychosis, but there is only limited evidence to support this claim, especially in daily life.ObjectiveIn this study, we aimed to investigate whether exposure to childhood trauma (physical, emotional, and sexual abuse and physical and emotional neglect) moderates the cross-sectional and temporal associations between self-esteem and psychotic experiences in patients with psychotic disorders, their first-degree relatives, and controls.MethodsWe assessed momentary self-esteem and psychotic experiences in daily life using the experience sampling method in 139 patients with psychotic disorders, 118 first-degree relatives of patients with psychotic disorders, and 111 controls. Childhood trauma was measured using the Childhood Trauma Questionnaire. We fitted linear mixed models and added two-way and three-way interaction terms to test the hypotheses.ResultsThe association between momentary self-esteem and psychotic experiences in daily life was modified by prior exposure to high versus low levels of several types of childhood trauma, that is, physical (χ22=24.9, family-wise error-corrected P<.001) and sexual abuse (χ22=15.9, P<.001) and physical neglect (χ22=116.7, P<.001). Specifically, momentary self-esteem was associated with more intense psychotic experiences in patients exposed to high versus low levels of physical neglect, in relatives exposed to high versus low levels of physical abuse, and in relatives and controls exposed to high versus low levels of sexual abuse. When investigating temporal order, the results showed no evidence that childhood trauma modified the temporal associations between self-esteem at tn-1 and psychotic experiences at tn or those between psychotic experiences at tn-1 and self-esteem at tn.ConclusionsThe association between self-esteem and psychotic experiences in daily life was found to be stronger in those exposed to high versus low levels of several types of childhood trauma (ie, physical abuse, sexual abuse, and physical neglect).

Gene-environment interactions involving the catechol-O-methyltransferase Val(158)Met polymorphism (COMT(Val158Met)) have been implicated in the causation of psychosis. Evidence from general population studies suggests that Met/Met subjects are sensitive to stress, a trait associated with psychosis. We hypothesized that the Met allele would moderate the effects of stress on negative affect (NA) in controls, and on NA and psychosis in patients with a psychotic disorder. Thirty-one patients with a psychotic disorder and comorbid cannabis misuse and 25 healthy cannabis users were studied with the experience sampling method (ESM), a structured diary technique assessing current context and emotional and psychotic experiences in daily life. A significant interaction between COMT(Val158Met) genotype and ESM stress in the model of NA was found for patients (interaction chi(2) = 7.4, P = 0.02), but not for controls (interaction chi(2) = 3.8, P = 0.15). In the model of ESM psychosis, a significant interaction between COMT(Val158Met) genotype and ESM stress was also apparent (interaction chi(2) = 11.6, P < 0.01), with Met/Met patients showing the largest increase in psychotic experiences as well as NA in reaction to ESM stress. The findings suggest that the COMT(Val158Met) polymorphism moderates affective and psychotic responses to stress in patients with psychosis, providing evidence for gene-environment interaction mechanisms in the formation of psychotic symptoms.

Several integrated models of psychosis have implicated adverse, stressful contexts and experiences, and affective and cognitive processes in the onset of psychosis. In these models, the effects of stress are posited to contribute to the development of psychotic experiences via pathways through affective disturbance, cognitive biases, and anomalous experiences. However, attempts to systematically test comprehensive models of these pathways remain sparse. Using the Experience Sampling Method in 51 individuals with first-episode psychosis (FEP), 46 individuals with an at-risk mental state (ARMS) for psychosis, and 53 controls, we investigated how stress, enhanced threat anticipation, and experiences of aberrant salience combine to increase the intensity of psychotic experiences. We fitted multilevel moderated mediation models to investigate indirect effects across these groups. We found that the effects of stress on psychotic experiences were mediated via pathways through affective disturbance in all 3 groups. The effect of stress on psychotic experiences was mediated by threat anticipation in FEP individuals and controls but not in ARMS individuals. There was only weak evidence of mediation via aberrant salience. However, aberrant salience retained a substantial direct effect on psychotic experiences, independently of stress, in all 3 groups. Our findings provide novel insights on the role of affective disturbance and threat anticipation in pathways through which stress impacts on the formation of psychotic experiences across different stages of early psychosis in daily life.

BackgroundSeveral studies have shown that social isolation and loneliness are associated with the occurrence of psychotic experiences. However, dynamics of these phenomena in people with subclinical experiences, commonly referred to as psychotic-like experiences (PLEs), remains largely unknown. Therefore, in this study we performed a temporal network analysis to model dynamic predictions between social isolation, loneliness, negative affect, social stress, and PLEs. MethodsA total of 77 drug-naïve individuals with PLEs from a transdiagnostic sample were enrolled. Data were obtained using the experience sampling method (ESM). The ESM questionnaires were delivered during 7 consecutive days (6 assessments per day). Therefore, 3234 data entries were analyzed. ResultsSocial isolation predicted next-moment emergence of PLEs through the effects on loneliness and negative affect. Also, PLEs appeared to predict next-moment loneliness, but not social isolation, through the effects on negative affect. Social stress did not predict any variables in the network. However, it was predicted by previous-moment PLEs and social isolation. Negative affect had the highest in-strength and out-strength centrality. ConclusionsFindings from the present study indicate that social isolation might predict the emergence of PLEs through the effects of momentary loneliness and negative affect. Also, loneliness might be bidirectionally associated with PLEs. Interventions targeting negative affect and social isolation might be beneficial in people with PLEs.

Evidence has accumulated that implicates childhood trauma in the aetiology of psychosis, but our understanding of the putative psychological processes and mechanisms through which childhood trauma impacts on individuals and contributes to the development of psychosis remains limited. We aimed to investigate whether stress sensitivity and threat anticipation underlie the association between childhood abuse and psychosis. We used the Experience Sampling Method to measure stress, threat anticipation, negative affect, and psychotic experiences in 50 first-episode psychosis (FEP) patients, 44 At-Risk Mental State (ARMS) participants, and 52 controls. Childhood abuse was assessed using the Childhood Trauma Questionnaire. Associations of minor socio-environmental stress in daily life with negative affect and psychotic experiences were modified by sexual abuse and group (all p FWE < 0.05). While there was strong evidence that these associations were greater in FEP exposed to high levels of sexual abuse, and some evidence of greater associations in ARMS exposed to high levels of sexual abuse, controls exposed to high levels of sexual abuse were more resilient and reported less intense negative emotional reactions to socio-environmental stress. A similar pattern was evident for threat anticipation. Elevated sensitivity and lack of resilience to socio-environmental stress and enhanced threat anticipation in daily life may be important psychological processes underlying the association between childhood sexual abuse and psychosis.

Cognitive models of psychosis posit that reasoning biases are an important mechanism contributing to the formation of psychotic symptoms, in part through transforming anomalous experiences of aberrant salience into frank psychotic symptoms. This study aimed to investigate the interplay of liberal acceptance (LA) bias, which is a specific type of reasoning bias, and momentary aberrant salience in the development of paranoid and psychotic experiences in daily life in first-episode psychosis patients (FEP), at-risk mental state participants (ARMS), and controls. We used a novel experimental Experience Sampling Methodology (eESM) task for measuring LA bias (ie, decisions based on low probability estimates) and ESM measures of momentary aberrant salience and paranoid and psychotic experiences in 51 FEP, 46 ARMS, and 53 controls. We found evidence that LA bias was more likely to occur in FEP than in controls. Further, LA bias was associated with psychotic and paranoid experiences (all P < .007) and modified the association between momentary aberrant salience and psychotic experiences (χ2(df) = 7.4(2), P = .025) in ARMS, such that momentary salience was associated with more intense psychotic experiences in the presence of LA bias in ARMS, but not in FEP and controls. Our findings suggest that LA bias may be central for anomalous experiences such as momentary aberrant salience to increase intensity of psychotic experiences in at-risk individuals. Further, LA bias appears to be more likely to be present, but not directly linked to current intensity of psychotic experiences, in treated FEP. Novel eESM tasks open new avenues for targeting psychological processes under real-world conditions.

Personalized dose optimization is desirable to improve subjective well-being and support rehabilitation. Therefore, N = 1 trials investigating tools to self-manage functional outcomes during dose optimization are necessary. The aim of this pilot study was to determine in two N = 1 trials whether an experience sampling method (ESM) smartphone app could be used to monitor and detect changes in subjective well-being and psychotic experiences during and after dose reduction. Two participants with a psychotic disorder in remission underwent gradual dose reduction under a longitudinal self-monitoring paradigm, accompanied by regular clinical monitoring by the attending physician. Subjective well-being was monitored with an (ESM) app through momentary affective experience (positive and negative affect) and physical well-being (tiredness, feeling unwell, and pain). Momentary psychotic experiences were assessed with four items. Time-series linear regression models were used to detect changes in reduction phases compared to baseline. Whereas significant improvements in subjective well-being and psychotic experiences during dose reduction were detected in one participant, the opposite was demonstrated for the other participant, showing worsened subjective well-being and increased psychotic experiences in the reduction phase compared to baseline. Self-monitoring with an ESM smartphone app offers a tool for detecting changes in subjective well-being and psychotic experiences during antipsychotic dose reduction. In this way, ESM may increase an individual's sense of control and empowerment. It may further facilitate dose optimization and shared decision-making at an individual level, which is required considering the high heterogeneity in psychotic disorders. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

BackgroundExisting research shows that adults with an autism spectrum disorder (ASD) are more vulnerable to develop overt psychosis. However, studies investigating (subclinical) psychotic experiences (PE) in ASD are scarce, and it is unknown if PE are accompanied with more distress in adults with ASD compared to the general population. This study examined lifetime PE and accompanying distress, momentary PE levels, and the impact of daily life stress and negative affect (NA) on momentary PE in males and females with ASD compared to controls.MethodsIn 50 adults with ASD (males N= 26, females N= 24) and 51 adults without ASD (males N= 26, females N= 25), the Community Assessment of Psychic Experiences (CAPE) was used to analyze group differences in frequency and distress of lifetime subclinical positive, negative, and depressive symptoms. The Experience Sampling Method (ESM) was used to measure momentary PE, NA, and stress (activity-related, event-related, and social stress) for 10 days. Multilevel analyses were conducted to test whether stress and NA were associated with momentary PE and whether these associations were modified by group or sex.ResultsAdults with ASD reported more lifetime CAPE negative and depressive symptoms, but similar levels of PE, than controls. Higher levels of accompanying distress were found in participants with ASD for each subscale. With respect to ESM momentary PE, higher levels were reported by adults with ASD and a stronger association between event-related stress and momentary PE was found compared to controls. This was not the case for NA, activity-related, and social stress. Overall, no significant differences between male and female outcomes were found.ConclusionAdults with ASD are more prone to encounter lifetime subclinical negative and depressive symptoms and accompanying distress compared to adults without ASD. Similar levels of lifetime PE in both groups were still accompanied with more distress in the ASD group. Furthermore, higher levels of ESM momentary PE were found in participants with ASD. Additionally, event-related stress may act as a risk factor for PE in both females and males with ASD, with a stronger risk-increasing effect than in their control counterparts.

Childhood adversity is associated with a myriad of psychiatric symptoms, including psychotic experiences (PEs), and with multiple psychological processes that may all mediate these associations. Using a network approach, the present study examined the complex interactions between childhood adversity, PEs, other psychiatric symptoms, and multiple psychological mediators (ie, activity-related and social stress, negative affect, loneliness, threat anticipation, maladaptive cognitive emotion regulation, attachment insecurity) in a general population, adolescent sample (n = 865, age 12-20, 67% female). Centrality analyses revealed a pivotal role of depression, anxiety, negative affect, and loneliness within the network and a bridging role of threat anticipation between childhood adversity and maladaptive cognitive emotion regulation. By constructing shortest path networks, we found multiple existing paths between different categories of childhood adversity and PEs, with symptoms of general psychopathology (ie, anxiety, hostility, and somatization) as the main connective component. Sensitivity analyses confirmed the robustness and stability of the networks. Longitudinal analysis in a subsample with Wave 2 data (n = 161) further found that variables with higher centrality (ie, depression, negative affect, and loneliness) better predicted follow-up PEs. Pathways linking childhood adversity to PEs are complex, with multifaceted psychological and symptom-symptom interactions. They underscore the transdiagnostic, heterotypic nature of mental ill-health in young people experiencing PEs, in agreement with current clinical recommendations.

Research has shown that heightened emotionality often precedes psychotic experiences. Understanding how individuals cope with these emotions is crucial for psychosis. While prior studies on emotion regulation (ER) and psychosis have mainly relied on self-report questionnaires, recent research has increasingly utilised daily life methods. This systematic review and meta-analysis seek to examine the relationship between daily ER and psychotic experiences. In total, 15 studies were included in the meta-analysis (21 in the systematic review). The results of Experience Sampling Methods (ESM) studies indicated that ER strategies of avoidance, reappraisal, repetitive thinking, and emotional suppression are not associated with psychotic experiences in daily life. The effect was not moderated by type of sample (clinical vs non-clinical), symptom (hallucination vs delusions), relation (contemporaneous vs perspective), or other methodological variables. Acceptance was found to be negatively associated with psychotic experiences, but the effect was small. These results indicate that ER in daily life might not impact directly on psychotic experiences. The results are discussed in light of conceptual and methodological limitations in the field.