Can We Ameliorate Psychotic Symptoms by Improving Implicit Self-Esteem? A Proof-of-Concept Experience Sampling Study of an Evaluative Classical Conditioning Intervention

Abstract

There is a need to develop novel interventions for psychosis, targeted at specific psychological mechanisms. We used a classical conditioning paradigm to a) modify implicit self-esteem and b) examine subsequent effects on subclinical psychotic symptoms measured by the Experience Sampling Methodology. This study is a proof-of-concept pilot investigation conducted with 28 students with high paranoia levels, assessing variations in their self-esteem, paranoid beliefs, and subclinical psychotic symptoms daily. After 2 days, participants were randomized to receive either a positive conditioning task (repeatedly pairing self-relevant words with an image of a smiling face) or a neutral conditioning task (repeatedly pairing self-relevant words with random smiling, angry, or neutral faces). After the intervention, the positive conditioning participants showed significantly higher levels of implicit self-esteem and lower subclinical psychotic symptoms than the control condition participants. This study demonstrated that implicit self-esteem can be increased by using a classical conditioning task.

Self-Schemas and Self-Esteem Discrepancies in Subclinical Paranoia: The Essential Role of Depressive Symptoms

“…Further research is needed for a better understanding of the measures that seek to delve into the non-conscious psychological processes. Similarly, further studies should be carried out in order to gain more in-depth knowledge about SE discrepancies in clinical and subclinical paranoia, as reducing maladaptive SE discrepancies could be an effective strategy to reduce paranoid ideation (37,79).…”

Paranoia, self-deception and overconfidence

“…Our data suggest this effect might be driven by self-deception secondary to an experience of one's own perceptual unreliability. Furthermore, boosting self-esteem-by conditioning positive selfassociations-appears to mollify paranoia [45], it ought to similarly diffuse self-deception.…”

Self-esteem and psychosis in daily life: An experience sampling study.

“…To date, self-esteem has been most commonly assessed using self-report measures that allow for computing sum or mean scores to index global self-esteem (Rosenberg, 1965). More recently, however, it has also been measured in daily life using the Experience Sampling Method (ESM; Espinosa et al, 2018;Monsonet et al, 2020;Thewissen et al, 2007Thewissen et al, , 2008. The ESM is a time-sampling self-assessment diary technique to assess moment-to-moment variation in thoughts, feelings, and behavior as they naturally occur in daily life (Csikszentmihalyi & Larson, 1987).…”

“…Several psychological processes have been posited to play an important role in the early stages of psychotic disorder (Espinosa et al, 2018; Freeman & Garety, 2003; Krabbendam et al, 2002; Monsonet et al, 2020; Palmier-Claus, Dunn, Drake, Lewis, 2011; Palmier-Claus, Dunn, Morrison, Lewis, 2011; Thewissen et al, 2007, 2008;). More specifically, self-esteem, commonly described as attitudes or beliefs toward the self (Rosenberg, 1965), or as subjective self-evaluations of one’s own worth as a person (Leary & MacDonald, 2003), has been implicated as a contributing factor not only in the development and formation (Bentall et al, 1994; Garety et al, 2001; Kinderman & Bentall, 1996; Smith et al, 2006), but also maintenance and severity of psychotic symptoms (Garety et al, 2001; Kesting et al, 2013).…”