Stress Sensitivity, Aberrant Salience, and Threat Anticipation in Early Psychosis: An Experience Sampling Study.

Ulrich Reininghaus,Adanna Onyejiaka,Philip Mcguire,Paola Dazzan,Til Wykes,Jim Van Os,Valeria Mondelli,Lucia Valmaggia,Wolfgang Viechtbauer,Matthew J Kempton,Robin M Murray,Craig Morgan,Kathryn Hubbard,Philippa Garety,Helen L Fisher,Stephanie Beards,Inez Myin-Germeys,Carmine M Pariante ,John W Mills ,Suzanne Ho‐Wai So ,Tom Craig ,Charlotte Gayer‐Anderson

doi:10.1093/schbul/sbv190

Abstract

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.

Highlights

Subclinical psychotic experiences are common in the general population[1,2,3] and associated with an increased probability of developing a psychotic disorder.[1]
While there is evidence that minor stressors are associated with psychotic experiences,[20,21,22,26,27] no study has tested whether elevated stress sensitivity per se contributes to the development of more intense psychotic experiences in daily life
A modified version of the 3-item experience sampling method (ESM) measure of aberrant salience by So67 was employed, asking participants to rate the following items on a 7-point Likert scale: “Everything grabs my attention ”, “Everything seems to have meaning ”, and “I notice things that I haven’t noticed before.”[67]. Our ESM measure of threat anticipation was based on a self-report format used for assessing this mechanism in previous cross-sectional studies asking participants to rate the likelihood of negative events happening to them in the future.[14,45,46,68]

Summary

Introduction

Subclinical psychotic experiences are common in the general population[1,2,3] and associated with an increased probability of developing a psychotic disorder.[1]. The psychological mechanism most widely studied in daily life is elevated stress sensitivity, characterized by intense emotional reactions to minor stressors and routine daily hassles.[20,21] Previous research suggests emotional reactivity to minor stressful events, activities, and social situations is increased in individuals with enduring psychosis and in those with higher familial or psychometric risk.[20,21,22,23,24] One study of individuals with an at-risk mental state (ARMS), known as high-risk or ultra-high-risk state,[5,25] reported greater emotional reactivity to minor activity-related and social stress in this group.[26] no study has investigated the role of stress sensitivity in individuals with first-episode psychosis (FEP). While there is evidence that minor stressors are associated with psychotic experiences,[20,21,22,26,27] no study has tested whether elevated stress sensitivity (ie, more intense emotional reactions to minor stressors) per se contributes to the development of more intense psychotic experiences in daily life

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