A systematic review and meta‐analysis of the association between emotional stress reactivity and psychosis

Abstract

Aim Emotional stress reactivity may be a mediating factor in the association between trauma and psychosis. This review aimed to (i) identify, summarise and critically evaluate the link between emotional stress reactivity and psychotic experiences (ii) examine evidence for a 'dose–response' relationship between stress reactivity and psychosis in the wider psychosis phenotype (i.e., sub‐clinical symptoms). Methods Electronic database searches (PsychINFO, MEDLINE, EMBASE) were conducted for studies which investigated the link between stress reactivity and psychosis, psychotic symptoms, or a vulnerability to developing psychosis (wider phenotype). Cross‐sectional, experimental and experience sampling method study designs were eligible for inclusion. Results Fourty five eligible articles were identified (N participants = 8830). Narrative synthesis showed that increased emotional stress reactivity was associated with psychosis and subclinical psychotic experiences across all study designs, however, findings were inconsistent across studies. The preliminary meta‐analysis (k = 4, n = 383) showed increases in emotional stress reactivity was associated with higher negative affect in response to event‐related stress, in those with psychosis compared to controls (mean difference in beta coefficients = 0.05, 95% CI 0.02–0.08, p = .004). However, this difference was small with a considerable degree of heterogeneity (p = .001, I2 = 81%) so results should be interpreted with caution. Conclusions Overall, the evidence suggests that there is a link between emotional stress reactivity and psychosis in those with psychosis, those at high risk of developing psychosis and in relation to subclinical psychotic‐like experiences in the general population.

Pathways from childhood trauma to aberrant salience: A structural equation approach to mentalization model

“…It has previously been found that emotional reactivity to stress may lead to positive symptomatic states in sub‐clinical (Kwapil et al, 2012; Muddle et al, 2021; Pries et al, 2020) and clinical samples (Klippel et al, 2021; So et al, 2018). The current study builds on these findings by identifying attachment avoidance, not anxiety, as a possible maintaining factor to stress reactivity.…”

Daily-life stress reactivity and recovery following virtual-reality-based cognitive behavioral therapy in patients with a psychotic disorder

“…( 8 ) suggested that the level of vulnerability to psychosis mirrored the level of emotional stress reactivity. Taken together, emotional stress sensitivity (i.e., reactivity and recovery) has been shown to be an important mechanism in the pathway to psychosis ( 9 , 10 ).…”

Amygdala subdivisions exhibit aberrant whole-brain functional connectivity in relation to stress intolerance and psychotic symptoms in 22q11.2DS

“…Furthermore, various studies have reported that anxiety and emotional dysregulation are associated with poorer prognoses for high-risk patients (7,8). Specifically, reduced tolerance to daily life stress has been represented a critical symptom that mediates the transition of patients to psychosis (9)(10)(11)(12)(13). Still, the neurobiological mechanisms underlying the link between stress and psychosis vulnerability remain poorly characterized.…”