Pinpointing affective disturbances in psychosis: A comparison of temporal affect dynamics in individuals with psychotic disorders, individuals with attenuated psychotic symptoms, and clinical and healthy controls

Predicting emotions across schizotypy levels

Successfully navigating the social world requires making accurate predictions about others. Individual differences in emotion prediction-the ability to predict someone's subsequent emotion given their current emotional state-can lead to variability in social success. In this study (N = 1024) we found evidence that individuals with heightened schizotypy displayed worse emotion prediction accuracy. This difficulty with emotion prediction was associated with increased loneliness, diminished social support, and smaller social networks, partially mediating some of the social difficulties in individuals with heightened schizotypy. Individuals with heightened schizotypy showed disruptions to key sources of affective information, meaning they had less reliable information about how emotions work when making emotion predictions. Specifically, their own emotion experiences were less typical, and their perception of others' emotions was less accurate. These findings highlight emotion prediction as a key social cognitive construct that should be considered in future research for individuals across the schizophrenia spectrum.

Predicting experiences of paranoia and auditory verbal hallucinations in daily life with ambulatory sensor data - A feasibility study

BACKGROUND

Prediction models that can detect the onset of psychotic experiences are a key component of developing Just-In-Time Adaptive Interventions (JITAI). Building these models on passively collectable data could substantially reduce user burden. In this study, we developed prediction models to detect experiences of auditory verbal hallucinations (AVH) and paranoia using ambulatory sensor data and assessed their stability over 12 weeks.

METHODS

Fourteen individuals diagnosed with a schizophrenia-spectrum disorder participated in a 12-day Ecological Momentary Assessment (EMA) study. They wore ambulatory sensors measuring autonomic arousal (i.e., electrodermal activity, heart rate variability) and completed questionnaires assessing the intensity/distress of AVHs and paranoia once every hour. After 12 weeks, participants repeated the EMA for four days for a follow-up assessment. We calculated prediction models to detect AVHs, paranoia, and AVH-/paranoia-related distress using random forests within nested cross-validation. Calculated prediction models were applied to the follow-up data to assess the stability of prediction models.

RESULTS

Prediction models calculated with physiological data achieved high accuracy both for AVH (81%) and paranoia (69%-75%). Accuracy increased by providing models with baseline information about psychotic symptom levels (AVH: 86%; paranoia: 80%-85%). During the follow-up EMA accuracy dropped slightly throughout all models but remained high (73%-84%).

CONCLUSIONS

Relying solely on physiological data to detect psychotic symptoms achieved substantial accuracy that remained sufficiently stable over 12 weeks. Experiences of AVHs can be predicted with higher accuracy and long-term stability than paranoia. The findings tentatively suggest that psychophysiology-based prediction models could be used to develop and enhance JITAIs for psychosis.

The use of Experience Sampling Method in psychopharmacological studies: A systematic review

The Experience Sampling Method (ESM) is increasingly used to validate and assess treatment effects. We conducted a systematic review to update, and extend, the previous review by Bos et al. (2015), by performing literature searches in PubMed, PsycInfo, and EMBASE. Search queries included every DSM-disorder, ATC-listed psychotropic medication, and multiple search-terms for ESM. Studies included medicated psychiatric patients who filled-out ambulatory prompts ≥2/day. Templates served to distil research themes. The majority of the 79 included studies involved substance use- (n = 47), mood- (n = 17), and psychotic disorders (n = 11). Less studied were anxiety disorders and PTSD (n = 3), and ADHD (n = 1). We identified six research themes:1)Effects of psychopharmacological treatment on symptoms and factors influencing outcome, 2)Fluctuations of psychiatric symptoms in medicated patients, 3)Prediction of relapse, exacerbation of symptoms or medication non-compliance, 4)Added value of ESM compared to care as usual, 5)Using ESM to establish treatment response-trajectories, 6)Acceptability and feasibility of newly-devised ESM-applications. This review reveals that ESM is predominantly used in psychopharmacological studies to monitor treatment effects and establish fluctuations of momentary psychiatric symptoms. Future research might facilitate personalising psychopharmacological prescribing decisions using ESM. Currently underrepresented patient groups include elderly patients, and personality disorders. Finally, to facilitate ESM-implementation multiple context-levels should be optimised.

Relations between psychosis and emotion regulation in daily life: A systematic review and meta-analyses of studies using experience sampling methods

Research has shown that heightened emotionality often precedes psychotic experiences. Understanding how individuals cope with these emotions is crucial for psychosis. While prior studies on emotion regulation (ER) and psychosis have mainly relied on self-report questionnaires, recent research has increasingly utilised daily life methods. This systematic review and meta-analysis seek to examine the relationship between daily ER and psychotic experiences. In total, 15 studies were included in the meta-analysis (21 in the systematic review). The results of Experience Sampling Methods (ESM) studies indicated that ER strategies of avoidance, reappraisal, repetitive thinking, and emotional suppression are not associated with psychotic experiences in daily life. The effect was not moderated by type of sample (clinical vs non-clinical), symptom (hallucination vs delusions), relation (contemporaneous vs perspective), or other methodological variables. Acceptance was found to be negatively associated with psychotic experiences, but the effect was small. These results indicate that ER in daily life might not impact directly on psychotic experiences. The results are discussed in light of conceptual and methodological limitations in the field.

Emotional experiences in male and female participants with schizophrenia spectrum disorders and healthy controls: an experience sampling method study

AIM

Schizophrenia spectrum disorders (SSD) are associated with disturbances in emotional experience, but sex differences and comparisons to healthy controls (HC) remain poorly explored. This exploratory study used Experience Sampling Method (ESM) to examine emotional variability, instability and daily/hourly patterns of positive and negative emotions across sexes in SSD and HC.

METHODS

A total of 103 SSD participants (47.9%) were compared to 112 HC (52.1%), matched for sex and age. Data on sociodemographics, clinical status, functioning and quality of life were collected. ESM assessed emotional experiences over one week.

RESULTS

For positive emotions, HC males reported higher levels on weekdays and morning-to-midday hours, whereas no sex differences emerged in SSD. Males with SSD showed greater weekly variability in positive emotions than HC males, while no significant differences were found among females. For negative emotions, females with SSD exhibited greater daily variability than female HC, with no significant sex differences within HC or SSD. Regarding emotional instability, female HC displayed higher instability than HC males, while no significant sex differences emerged in SSD.

CONCLUSION

This study shows significant sex differences in emotional experiences among SSD and HC, with different sex patterns in SSD. Targeted, sex-specific interventions are crucial for improving emotional regulation and treatment outcomes in SSD.Trial registration: ISRCTN.org identifier: ISRCTN21141466.

Higher emotion regulation flexibility predicts more stable negative emotions and faster affective recovery in early psychosis: an experience sampling study

BACKGROUND

While evidence shows that people with early psychosis are flexible in using different emotion regulation (ER) strategies to manage the varying contextual demands, no studies have examined the effectiveness of such regulatory flexibility in this population. We addressed this issue by investigating whether and how ER flexibility relate to different dynamic aspects (variability, instability, inertia, and recovery) of negative affect (NA) in a combined early psychosis sample, consisting of both individuals at high clinical risk for psychosis and those diagnosed with first-episode psychosis.

METHODS

Participants were 148 individuals from the INTERACT project, a multi-center randomized controlled trial on the efficacy of acceptance and commitment therapy in early psychosis. We utilized data from the baseline assessment, during which all participants completed six days of experience sampling assessment of momentary NA, as well as end-of-day assessments of ER strategy use.

RESULTS

Multilevel models of within-person associations showed that greater ER flexibility was associated with more stable NA, and quicker recovery of NA from stressors during the day. Linear regression analyses of between-person associations showed that people who had more variable and unstable NA reported greater ER flexibility generally. No evidence was found for associations with NA inertia.

CONCLUSIONS

The current study identified unique within-person and between-person links between ER flexibility and dynamics of NA in early psychosis. These findings further provide evidence for ER flexibility in early psychosis, emphasizing the adaptive nature of regulatory flexibility in relation to reduced instability in NA and faster recovery from NA in everyday life.

Emotion regulation flexibility and psychosis: A longitudinal study disentangling components of flexibility in psychosis-proneness

OBJECTIVES

Flexibility in self-regulation has emerged as an important component of mental health. Previous findings found that deficits in two components of regulatory flexibility were linked cross-sectionally to psychosis-proneness. We aimed to replicate and extend these findings longitudinally.

METHODS

We measured psychosis-proneness and components of emotion regulation flexibility (i.e. context sensitivity, repertoire and feedback) at two time points with three months in between.

RESULTS

Two flexibility components predicted psychotic-like experiences. The ability to detect the absence of contextual cues was implicated in both positive and negative dimensions but through opposite pathways. Expressive suppression ability-a subcomponent of repertoire-predicted positive symptoms. None of the flexibility components predicted distress related to the symptoms.

CONCLUSIONS

The current study provides further evidence on the implication of emotion regulation flexibility in the longer-term maintenance of psychotic-like experiences. Future studies can advance this work further by evaluating possible bidirectional relationships between psychotic-like experiences and deficits in emotion regulation flexibility.

Using Smartphones to Identify Momentary Characteristics of Persecutory Ideation Associated With Functional Disability

Objectives

Though often a feature of schizophrenia-spectrum disorders, persecutory ideation (PI) is also common in other psychiatric disorders as well as among individuals who are otherwise healthy. Emerging technologies allow for a more thorough understanding of the momentary phenomenological characteristics that determine whether PI leads to significant distress and dysfunction. This study aims to identify the momentary phenomenological features of PI associated with distress, dysfunction, and need for clinical care.

Methods

A total of 231 individuals with at least moderate PI from 43 US states participated in a study involving 30 days of data collection using a smartphone data collection system combining ecological momentary assessment and passive sensors, wherein they reported on occurrence of PI as well as related appraisals, responses, and cooccurring states. Most (N = 120, 51.9%) participants reported never having received treatment for their PI, while 50 participants had received inpatient treatment (21.6%), and 60 (26.4%) had received outpatient care only.

Results

Individuals with greater functional disability did not differ in PI frequency but were more likely at the moment to describe threats as important to them, to ruminate about those threats, to experience distress related to them, and to change their behavior in response. Groups based on treatment-seeking patterns largely did not differ in baseline measures or momentary phenomenology of PI as assessed by self-report or passive sensors.

Conclusions

Smartphone data collection allows for granular assessment of PI-related phenomena. Functional disability is associated with differences in appraisals of and responses to PI at the moment.