Psychological Pathways to Paranoia and Psychotic-Like Experiences in Daily-Life: The Mediating Role of Distinct Affective Disturbances

Abstract

Background and Hypothesis Influential models of psychosis indicate that the impact of putative causal factors on positive symptoms might be explained partly through affective disturbances. We aimed to investigate whether pathways from stress and self-esteem to positive symptoms, as well as reversal pathways from symptoms to stress and self-esteem, were mediated through specific affective disturbances across the extended psychosis phenotype. Study Design Using experience sampling methodology, 178 participants (65 high-schizotypy, 74 at-risk mental state, and 39 first-episode psychosis) were assessed on levels of momentary stress, self-esteem, anxiety, sadness, psychotic-like experiences (PLE), and paranoia. Multilevel mediation models were fit to examine indirect effects of each of these pathways. Considering evidence of mediation, each indirect pathway will be combined in a single model to explore their relative contributions. Study Results Anxiety, sadness, and self-esteem mediated the pathways from stress to PLE and paranoia in daily-life. In the pathway to paranoia, sadness, and self-esteem showed larger contributions than anxiety. Pathways from self-esteem to PLE and paranoia were mediated by anxiety and sadness, the later showing a larger contribution. Pathways from symptoms to stress, but not from symptoms to self-esteem, were differently explained by emotional states; sadness lost its mediating effect and anxiety was the most important mediator. Few differences across groups were found. Conclusions This study lends support to psychological models of psychosis that highlight the relevance of affective disturbances in the risk and expression of psychosis. Furthermore, specific influences of different negative emotional states were identified, which could enhance psychological treatments.

The Role of Shame in Schizophrenia Delusion

“…This is in line with recent approaches ( e.g. , the experience sampling method) (Monsonet et al, 2022), aimed to detect subjective experiences in daily life. Such techniques may help monitor emotional experiences to provide interventions to minimize negative emotions, enhance self-esteem in real-world situations, and reduce such behavioral concomitants ( e.g.…”

“…In particular, our results indicate how such dynamic mechanisms may be at work in patients with schizophrenia, through the role of shame and the underlying feeling of attack on self-esteem. Consistently, recent research (Monoset et al, 2022) suggests that affective disturbances similarly underlie high schizotypy, at-risk mental state, and first-episode psychosis subjects, highlighting an etiological and phenomenological continuity across the psychosis continuum. Therefore, delusional phenomenon seems to be an extreme expression of a continuously distributed phenotype (Freeman, 2006), in which affective and nonaffective dispositions interact with each other in conditioning its severity (Tonna et al, 2011, 2012).…”

“…The identification of specific emotional traits in patients with schizophrenia may help target personalized therapeutic interventions in patients with schizophrenia, according to a recovery-focused treatment approach (Marchesi et al, 2014;Velligan and Gonzalez, 2007). This is in line with recent approaches (e.g., the experience sampling method) (Monsonet et al, 2022), aimed to detect subjective experiences in daily life. Such techniques may help monitor emotional experiences to provide interventions to minimize negative emotions, enhance self-esteem in real-world situations, and reduce such behavioral concomitants (e.g., avoidance and withdrawal) that may hinder opportunities to receive corrective feedback.…”

Methodological Characteristics and Feasibility of Ecological Momentary Assessment Studies in Psychosis: a Systematic Review and Meta-Analysis

“…Few studies examined the influence of methodology on completion rates, with one study finding advantage of smartphone app over an SMS-delivered EMA protocol 35 and another finding no difference between PDA and smartphone app delivery. 71 Four (of 8) studies found completion reduced over time and there was no effect of personalized feedback (vs. no feedback). Similarly, there was no evidence from the meta-regression findings that EMA completion rates were associated with protocol length and duration, inpatient status, or participant age, nor was there any association with other clinical or demographic variables.…”

Low status, humiliation, dopamine and risk of schizophrenia

“…An Experience Sampling and Monitoring (ESM)-study of a mixed clinical/nonclinical sample showed that a decrease in self-esteem was associated with an immediate increase in paranoia (Thewissen, Bentall, Lecomte, van Os, & Myin-Germeys, 2008 ). A recent study investigated three types of subjects (high level schizotypy, at risk mental state, first psychotic episode) and reported that low self-esteem, anxiety and sadness mediated the pathway from stress to psychotic-like experiences and paranoia in daily life (Monsonet, Rockwood, Kwapil, & Barrantes-Vidal, 2022 ).…”