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

Abstract

Several integrated models of psychosis have implicated adverse, stressful contexts and experiences, and affective and cognitive processes in the onset of psychosis. In these models, the effects of stress are posited to contribute to the development of psychotic experiences via pathways through affective disturbance, cognitive biases, and anomalous experiences. However, attempts to systematically test comprehensive models of these pathways remain sparse. Using the Experience Sampling Method in 51 individuals with first-episode psychosis (FEP), 46 individuals with an atrisk mental state (ARMS) for psychosis, and 53 controls, we investigated how stress, enhanced threat anticipation, and experiences of aberrant salience combine to increase the intensity of psychotic experiences. We fitted multilevel moderated mediation models to investigate indirect effects across these groups. We found that the effects of stress on psychotic experiences were mediated via pathways through affective disturbance in all 3 groups. The effect of stress on psychotic experiences was mediated by threat anticipation in FEP individuals and controls but not in ARMS individuals. There was only weak evidence of mediation via aberrant salience. However, aberrant salience retained a substantial direct effect on psychotic experiences, independently of stress, in all 3 groups. Our findings provide novel insights on the role of affective disturbance and threat anticipation in pathways through which stress impacts on the formation of psychotic experiences across different stages of early psychosis in daily life.

30 Years on: How the Neurodevelopmental Hypothesis of Schizophrenia Morphed Into the Developmental Risk Factor Model of Psychosis

“…41 Now real-time sampling techniques have shown that patients with schizophrenia have greater sensitivity to everyday hassles than do controls and have linked even mild stress to increases in psychotic symptoms. 42 Such findings extended the neurodevelopmental model and led to the proposal of a parallel sociodevelopmental model. 43 Increasing attention was also paid to drug-induced psychosis 44 and in particular to the role of cannabis.…”

Experience sampling methodology in mental health research: new insights and technical developments

“…In addition, these traumatic experiences were also linked to stronger psychotic reactivity to threat anticipation in daily life in individuals at the more severe end of the psychosis continuum. Interestingly, mediation analyses revealed that the effect of daily stressors on psychotic experiences was not only mediated by affective reactivity, but also by threat anticipation in first‐episode psychosis patients.…”

“…As affective disturbances mediate the effect of daily hassles on psychotic experiences 53 , an affective pathway to psychosis has been proposed 54 . In line with this, ESM studies have shown that exposure to social adversity, such as childhood trauma 50,[55][56][57][58][59] and major life events 60,61 , is associated with increased reactivity even to minor stressors in daily life, suggesting a process of behavioural sensitization 62 .…”

The Cascade of Stress: A Network Approach to Explore Differential Dynamics in Populations Varying in Risk for Psychosis

“…13,42 In the network of patients, connections suggested that the negative affect item 'down' had an intermediary position between minor daily stress, psychotic experiences, and other mental states (such as 'insecure' and 'anxious'). Anxiety was not directly connected to psychotic experiences but based on the reported network connections that link anxiety with other negative affective experiences we can hypothesize that anxiety may be connected to psychotic experiences through moods such as 'down' and 'insecure'.…”