Psychological processes underlying the association between childhood trauma and psychosis in daily life: an experience sampling study

Abstract

BackgroundEvidence 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.MethodWe 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.ResultsAssociations of minor socio-environmental stress in daily life with negative affect and psychotic experiences were modified by sexual abuse and group (all pFWE < 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.ConclusionsElevated 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.

Modeling the Interplay Between Psychological Processes and Adverse, Stressful Contexts and Experiences in Pathways to Psychosis: An Experience Sampling Study

“…13 Our findings provide new evidence in support of this proposition, as this is the first ESM study to report that affective disturbance mediates the link from momentary stress to PE in daily life across different stages of early psychosis. In contrast to findings from previous research suggesting some degree of specificity for certain types of stressors for the formation of PE, 18 we found evidence that the effects of all stress variables (ie, event-related, activity-related, and social stress) were mediated via pathways through affective disturbances. Further, while indirect effects of activity-related stress were greatest, there was no strong evidence of differences in magnitude of indirect effects via affective disturbance for different types of stressors.…”

“…These items have been reported to show high levels of internal consistency in previous studies (Cronbach's alpha = 0.80) 37 as well as in the current study (Cronbach's α = 0.90). 18 They have been further shown to have good convergent validity with interviewer-rated measures of psychosis (r = .45, P < .001) the PANSS (r = .45; P < .001) 37 as well as good concurrent validity with negative affect (r = .68, P < .001).…”

“…17 Previous research further suggest some degree of specificity, for example, of elevated emotional reactivity to social but not event-related stress as a putative mechanism underlying the association between childhood trauma and psychosis. 18 Affective disturbances, more generally, have been shown to be linked to PE across different stages along the psychosis continuum. [19][20][21][22][23][24][25] Cognitive models of psychosis provide a detailed specification of the cognitive processes associated with emotional responses to stress and consider cognitive biases, such as a hypervigilance for threat, to be involved in stress reactivity.…”

Letter to the Editor: Beyond childhood trauma – stressful events early and later in life in relation to psychotic experiences

“…As suggested by Reininghaus et al (2016), early trauma may have an impact on these subjective reactions to later stressors. Indeed, we found that childhood trauma severity correlated with impact, helplessness and perceived danger of later stressful events.…”

“…In the context of psychotic disorders, Reininghaus et al (2016) recently found support for the notion that enhanced sensitivity and increased threat anticipation to stress are important psychological mechanisms in the pathways from childhood trauma to psychosis (as put forward by Morgan & Hutchinson, 2010). The question is whether these mechanisms are relevant to the development of psychotic symptoms with a need for care, or merely contribute to a more general vulnerability for psychotic experiences, including those without a need for care.…”