The affective reactivity of psychotic speech: The role of internal source monitoring in explaining increased thought disorder under emotional challenge

Abstract

Thought disorder (TD) has been shown to vary in relation to negative affect. Here we examine the role internal source monitoring (iSM, i.e. ability to discriminate between inner speech and verbalized speech) in TD and whether changes in iSM performance are implicated in the affective reactivity effect (deterioration of TD when participants are asked to talk about emotionally-laden topics). Eighty patients diagnosed with schizophrenia-spectrum disorder and thirty healthy controls received interviews that promoted personal disclosure (emotionally salient) and interviews on everyday topics (non-salient) on separate days. During the interviews, participants were tested on iSM, self-reported affect and immediate auditory recall. Patients had more TD, poorer ability to discriminate between inner and verbalized speech, poorer immediate auditory recall and reported more negative affect than controls. Both groups displayed more TD and negative affect in salient interviews but only patients showed poorer performance on iSM. Immediate auditory recall did not change significantly across affective conditions. In patients, the relationship between self-reported negative affect and TD was mediated by deterioration in the ability to discriminate between inner speech and speech that was directed to others and socially shared (performance on the iSM) in both interviews. Furthermore, deterioration in patients' performance on iSM across conditions significantly predicted deterioration in TD across the interviews (affective reactivity of speech). Poor iSM is significantly associated with TD. Negative affect, leading to further impaired iSM, leads to increased TD in patients with psychosis. Avenues for future research as well as clinical implications of these findings are discussed.

The role of social isolation and social cognition in thought disorder

“…It follows that during moments of heightened arousal, the ability to mentalize (along with other psychological processes) may become depleted leading to the intrusion of decontextualised concerns and worries (Harrow et al, 1989), and to an unawareness, on the patient"s part, that communication has gone awry. Such hypothesis is consistent with our own findings that mentalization and delusional beliefs make independent contributions to TD but also with evidence that TD worsens when patients are asked to talk about emotionally salient topics (de Sousa et al, 2016).…”

“…social isolation is a sufficient condition for TD, but rather that social isolation, in combination with other psychological and affective processes (e.g. negative affect; de Sousa et al, 2016), may be a necessary condition to increase the likelihood of TD through its impact on social cognition. Chronic social isolation and social withdrawal (ubiquitous in prodromal stages) may have a deleterious effect on socio-cognitive development in psychotic patients.…”

“…However, it is important to acknowledge that TD (manifested in communication with others) occurs in an environmental context and that emotional and social factors are crucial for understanding its development and maintenance. For example, there is a considerable volume of research documenting the impact of stress or arousal of negative affect on TD in patients (de Sousa et al, 2016;Docherty, 1996).…”

Inner Speech and Clarity of Self-Concept in Thought Disorder and Auditory-Verbal Hallucinations

“…As detailed elsewhere (De Sousa et al, 2016), our clinical group exhibited more TD than our comparison group, especially during the salient interview. They also reported more negative affect in both interviews, and, as expected, this difference was more pronounced in the salient interview.…”

Disorganisation, thought disorder and socio-cognitive functioning in schizophrenia spectrum disorders

“…For example, it is a well-established finding that thought disorder worsens when patients are asked to talk about personally and emotionally salient topics, a phenomenon known as the affective reactivity of speech effect. 75,76 It follows that if social cognition is important in thought disorder, then the relationship may well be more evident during an acute in-patient admission.…”