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Raugh IM, Strauss GP. Integrating mindfulness into the extended process model of emotion regulation: The dual-mode model of mindful emotion regulation. Emotion 2024; 24:847-866. [PMID: 37843512 PMCID: PMC11009092 DOI: 10.1037/emo0001308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Extensive research has been conducted regarding how people manage their emotions. Within this research, there has been growing attention toward the role of mindfulness in emotion regulation. While prior reviews have discussed mindfulness in the context of emotion regulation, they have not provided a thorough integration using the prevailing models of emotion regulation or mindfulness. The present review discusses the Extended Process Model of Emotion Regulation and Monitoring and Acceptance Theory of mindfulness in order to propose a novel integrated framework, the Dual-mode Model of Mindful Emotion Regulation (D-MER). This model proposes two "modes" of mindfulness: Implementation and facilitation. Implementation posits that mindfulness skills can be used as emotion regulation strategies through attentional deployment and cognitive change. Facilitation posits that mindfulness as a state or trait affects emotion generation and regulation through effects on cognitive processes and positive or negative valence systems. Further, the D-MER posits that mindfulness experience can improve the efficiency of mindfulness-based emotion regulation strategies (implementation) while effects of mindfulness on emotion regulation processes become increasingly trait-like and automatic over time (facilitation). Empirical and theoretical support for this model are discussed, specific hypotheses to guide further research are provided, and clinical implications are presented. Use of this model may identify mechanisms underlying the interaction between mindfulness and emotion regulation which can be used in ongoing affective and clinical research. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Raugh IM, Strauss GP. Trait Mindfulness in Psychotic Disorders: Dimensions Predicting Symptoms, Cognition, and Functional Outcome. Behav Ther 2024; 55:55-67. [PMID: 38216237 PMCID: PMC10787159 DOI: 10.1016/j.beth.2023.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 01/14/2024]
Abstract
Mindfulness-based treatments are efficacious for psychotic disorders (PD). However, which components of mindfulness (i.e., attentive monitoring and nonjudgmental acceptance) are most relevant treatment targets is unclear. Further, there is a dearth of literature examining clinical correlates of mindfulness in people with PD. The present study aimed to examine group differences and clinical correlates of mindfulness in people with PD. We hypothesized that PD would report lower monitoring and acceptance than CN and that mindfulness components would be associated with symptoms including dysfunctional beliefs, alexithymia, neurocognitive ability, positive symptoms, and mood symptoms. Groups included individuals with PD (n = 54) and nonpsychiatric controls (n = 55). Participants completed self-report measures of mindfulness and related constructs and clinical interviews of symptoms. Results of ANOVA models indicated that global mindfulness was lower in PD relative to CN, with greatest differences evident for acceptance in the affective psychosis group. Regression models found that greater monitoring was associated with improved neurocognitive performance, while acceptance was associated with lower defeatist beliefs, alexithymia, and depression/anxiety symptoms. Results highlight the importance of targeting acceptance in the psychosocial treatment of PDs, especially for those with mood symptoms.
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Weiss B, Dinh-Williams LAL, Beller N, Raugh IM, Strauss GP, Campbell WK. Ayahuasca in the treatment of posttraumatic stress disorder: Mixed-methods case series evaluation in military combat veterans. Psychol Trauma 2023:2024-34611-001. [PMID: 38059941 DOI: 10.1037/tra0001625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
OBJECTIVE Although ayahuasca-a plant-based psychedelic-is discussed as promising in the treatment of posttraumatic stress disorder (PTSD), evidence so far remains limited to retrospective case reports and qualitative surveys. No study to date has examined whether ayahuasca results in prospective and clinically meaningful changes in trauma symptoms across individuals with PTSD symptoms. METHOD To address this gap, we conducted a convergent mixed-methods case series study on eight military veterans with PTSD who participated in a 3-day ayahuasca intervention in Central America. Clinically meaningful changes from pre- to posttreatment and at a 3-month follow-up were assessed in three ways using: (a) PTSD checklist-5 (PCL-5); (b) experience sampling measurement of momentary PTSD and mood symptoms; and (c) an open-ended survey on perceived benefits. RESULTS The majority (87.5%; 7/8) of participants demonstrated reliable and/or clinically significant changes in PCL-5 symptoms by posttreatment, which were maintained by 70% (5/7) of veterans by the 3-month follow-up. On average, veterans also reported significant improvements in momentary PTSD symptoms, as well as negative and positive affect in daily life posttreatment, with 63% (5/8) reporting moderate-to-large improvements in these domains. Broad themes characterizing the perceived benefits of ayahuasca included deep positive emotions, decentering/acceptance, and purpose in life; adverse acute experiences were, however, reported. CONCLUSIONS This study provides preliminary support for the clinically meaningful and lasting benefits of a brief ayahuasca intervention on PTSD/mood symptoms in military veterans. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Brandon Weiss
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | | | - Nick Beller
- Department of Clinical Psychology, Adler School of Professional Psychology
| | - Ian M Raugh
- Department of Psychology, University of Georgia
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Luther L, Raugh IM, Collins DE, Berglund A, Knippenberg AR, Mittal VA, Walker EF, Strauss GP. Environmental context predicts state fluctuations in negative symptoms in youth at clinical high risk for psychosis. Psychol Med 2023; 53:7609-7618. [PMID: 37246568 PMCID: PMC10755225 DOI: 10.1017/s0033291723001393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/17/2023] [Accepted: 04/26/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Negative symptoms (avolition, anhedonia, asociality) are a prevalent symptom in those across the psychosis-spectrum and also occur at subclinical levels in the general population. Recent work has begun to examine how environmental contexts (e.g. locations) influence negative symptoms. However, limited work has evaluated how environments may contribute to negative symptoms among youth at clinical high risk for psychosis (CHR). The current study uses Ecological Momentary Assessment to assess how four environmental contexts (locations, activities, social interactions, social interaction method) impact state fluctuations in negative symptoms in CHR and healthy control (CN) participants. METHODS CHR youth (n = 116) and CN (n = 61) completed 8 daily surveys for 6 days assessing negative symptoms and contexts. RESULTS Mixed-effects modeling demonstrated that negative symptoms largely varied across contexts in both groups. CHR participants had higher negative symptoms than CN participants in most contexts, but groups had similar symptom reductions during recreational activities and phone call interactions. Among CHR participants, negative symptoms were elevated in several contexts, including studying/working, commuting, eating, running errands, and being at home. CONCLUSIONS Results demonstrate that negative symptoms dynamically change across some contexts in CHR participants. Negative symptoms were more intact in some contexts, while other contexts, notably some used to promote functional recovery, may exacerbate negative symptoms in CHR. Findings suggest that environmental factors should be considered when understanding state fluctuations in negative symptoms among those at CHR participants.
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Affiliation(s)
- Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Ian M. Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
| | | | - Alysia Berglund
- Department of Psychology, University of Georgia, Athens, GA, USA
| | | | - Vijay A. Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
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Spilka MJ, Raugh IM, Berglund AM, Visser KF, Strauss GP. Reinforcement learning profiles and negative symptoms across chronic and clinical high-risk phases of psychotic illness. Eur Arch Psychiatry Clin Neurosci 2023; 273:1747-1760. [PMID: 36477406 DOI: 10.1007/s00406-022-01528-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
Negative symptoms are prominent in individuals with schizophrenia (SZ) and youth at clinical high-risk for psychosis (CHR). In SZ, negative symptoms are linked to reinforcement learning (RL) dysfunction; however, previous research suggests implicit RL remains intact. It is unknown whether implicit RL is preserved in the CHR phase where negative symptom mechanisms are unclear, knowledge of which may assist in developing early identification and prevention methods. Participants from two studies completed an implicit RL task: Study 1 included 53 SZ individuals and 54 healthy controls (HC); Study 2 included 26 CHR youth and 23 HCs. Bias trajectories reflecting implicit RL were compared between groups and correlations with negative symptoms were examined. Cluster analysis investigated RL profiles across the combined samples. Implicit RL was comparable between HC and their corresponding SZ and CHR groups. However, cluster analysis was able to parse performance heterogeneity across diagnostic boundaries into two distinct RL profiles: a Positive/Early Learning cluster (65% of participants) with positive bias scores increasing from the first to second task block, and a Negative/Late Learning cluster (35% of participants) with negative bias scores increasing from the second to third block. Clusters did not differ in the proportion of CHR vs. SZ cases; however, the Negative/Late Learning cluster had more severe negative symptoms. Although implicit RL is intact in CHR similar to SZ, distinct implicit RL phenotypic profiles with elevated negative symptoms were identified trans-phasically, suggesting distinct reward-processing mechanisms can contribute to negative symptoms independent of phases of illness.
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Affiliation(s)
- Michael J Spilka
- Department of Psychology, University of Georgia, Athens, GA, 30602, USA
| | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA, 30602, USA
| | - Alysia M Berglund
- Department of Psychology, University of Georgia, Athens, GA, 30602, USA
| | - Katherine F Visser
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Gregory P Strauss
- Department of Psychology, University of Georgia, Athens, GA, 30602, USA.
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Strauss GP, Zamani-Esfahlani F, Raugh IM, Luther L, Sayama H. Network analysis of discrete emotional states measured via ecological momentary assessment in schizophrenia. Eur Arch Psychiatry Clin Neurosci 2023; 273:1863-1871. [PMID: 37278749 DOI: 10.1007/s00406-023-01623-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 05/22/2023] [Indexed: 06/07/2023]
Abstract
Prior studies demonstrate that schizophrenia (SZ) is associated with abnormalities in positive and negative emotional experience that predict clinical presentation. However, it is unclear whether specific discrete emotions within the broader positive/negative categories are driving those symptom associations. Further, it is also unclear whether specific emotions contribute to symptoms in isolation or via networks of emotional states that dynamically interact across time. The current study used network analysis to evaluate temporally dynamic interactions among discrete emotional states experienced in the real world as assessed via Ecological Momentary Assessment (EMA). Participants included 46 outpatients with chronic SZ and 52 demographically matched healthy controls (CN) who completed 6 days of EMA that captured reports of emotional experience and symptoms derived from monetary surveys and geolocation based symptom markers of mobility and home location. Results indicated that less dense emotion networks were associated with greater severity of negative symptoms, whereas more dense emotion networks were associated with more severe positive symptoms and mania. Additionally, SZ evidenced greater centrality for shame, which was associated with greater severity of positive symptoms. These findings suggest that positive and negative symptoms are associated with distinct profiles of temporally dynamic and interactive emotion networks in SZ. Findings have implications for adapting psychosocial therapies to target specific discrete emotional states in the treatment of positive versus negative symptoms.
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Affiliation(s)
- Gregory P Strauss
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA, 30602, USA.
| | | | - Ian M Raugh
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA, 30602, USA
| | - Lauren Luther
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA, 30602, USA
| | - Hiroki Sayama
- Department of Systems Science and Industrial Engineering, Binghamton University, Binghamton, NY, USA
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Luther L, Westbrook A, Ayawvi G, Ruiz I, Raugh IM, Chu AOK, Chang WC, Strauss GP. The role of defeatist performance beliefs on cognitive effort-cost decision-making in schizophrenia. Schizophr Res 2023; 261:216-224. [PMID: 37801740 DOI: 10.1016/j.schres.2023.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 07/01/2023] [Accepted: 09/24/2023] [Indexed: 10/08/2023]
Abstract
Impairments in effort-cost decision-making have been consistently observed in people with schizophrenia (SZ) and may be an important mechanism of negative symptoms. However, the processes that give rise to impairments in effort-cost decision-making are unclear, leading to limited progress in identifying the most relevant treatment targets. Drawing from cognitive models of negative symptoms and goal-directed behavior, this study aimed to examine how and under what type of task conditions defeatist performance beliefs contribute to these decision-making processes. Outpatients with SZ (n = 30) and healthy controls (CN; n = 28) completed a cognitive effort allocation task, the Cognitive Effort-Discounting (COGED) task, which assesses participants' willingness to exert cognitive effort for monetary rewards based on parametrically varied working memory demands (completing N-back levels). Results showed that although participants with SZ demonstrated reduced willingness to work for rewards across N-back levels compared to CN participants, they showed less choice modulation across different N-back conditions. However, among SZ participants with greater defeatist performance beliefs, there was a reduced willingness to choose the high effort option at higher N-back levels (N-back levels 3, 4, and 5 versus 2-back). Results suggest that compared to CN, the SZ group's subjective willingness to expend effort largely did not dynamically adjust as cognitive load increased. However, defeatist beliefs may undermine willingness to expend cognitive effort, especially when cognitive task demands are high. These beliefs may be a viable treatment target to improve effort-cost decision-making impairments in people with SZ.
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Affiliation(s)
- Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA, USA.
| | | | - Gifty Ayawvi
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Ivan Ruiz
- Department of Psychology, University of Georgia, Athens, GA, USA; Department of Psychiatry, University of California, Los Angeles, USA
| | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Angel On Ki Chu
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong; Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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Cowan T, Rodriguez ZB, Strauss GP, Raugh IM, Cohen AS. Computerized analysis of facial expression reveals objective indices of blunted facial affect. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01696-6. [PMID: 37878034 DOI: 10.1007/s00406-023-01696-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/20/2023] [Indexed: 10/26/2023]
Abstract
Blunted affect is associated with severe mental illness, particularly schizophrenia. Mechanisms of blunted affect are poorly understood, potentially due to a lack of phenomenological clarity. Here, we examine clinician rated blunted affect and computerized facial metrics derived from ambulatory video assessment using machine learning. With high predictive accuracy (80-82%), we found that head orientation, eye movement, and facets of mouth movement were associated with clinical ratings of blunted affect. Features denoting larger muscle movements were associated with social cognition (R2 = 0.37) and cognition (R2 = 0.40). Findings provide potential insights on psychological and pathophysiological contributors to blunted affect.
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Affiliation(s)
- Tovah Cowan
- Department of Psychology, Center for Computation and Technology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA
| | - Zachary B Rodriguez
- Department of Psychology, Center for Computation and Technology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA
| | | | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Alex S Cohen
- Department of Psychology, Center for Computation and Technology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA.
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9
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Raugh IM, Bartolomeo LA, Zhang L, James SH, Strauss GP. Deconstructing emotion regulation in schizophrenia: The nature of abnormalities at the selection and implementation stages. J Psychopathol Clin Sci 2023; 132:908-920. [PMID: 37668572 PMCID: PMC10592206 DOI: 10.1037/abn0000852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
Difficulties with emotion regulation are observed across psychiatric diagnoses, including psychotic disorders. Past studies using trait self-report indicate that people with schizophrenia (SZ) are less likely to use adaptive emotion regulation strategies and more likely to use maladaptive emotion regulation strategies than controls (CN). However, more recent evidence using ecological momentary assessment (EMA) indicates that regulation effectiveness and adaptiveness may vary across strategies. The present study aimed to systematically understand abnormalities in state-level emotion regulation strategy selection, effectiveness, and adaptiveness in SZ compared to CN using EMA. Participants (n = 50 SZ; n = 53 CN) completed 6 days of EMA surveys assessing emotional experience, emotion regulation, and symptoms. Results indicated that SZ selected interpersonal emotion regulation and avoidance more often than CN, while both groups selected reappraisal and distraction more often than avoidance and suppression. Overall, strategies were effective at reducing negative emotion and adaptive for reducing delusions over time. Reappraisal, avoidance, and suppression all significantly down-regulated delusions over time. Although some selection abnormalities were present in terms of rate of selection and effort exertion, people with SZ select strategies which are effective and adaptive in the short term. The present results have implications for how cognitive therapy for psychosis may target delusions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Ian M Raugh
- Department of Psychology, University of Georgia
| | | | - Luyu Zhang
- Department of Psychology, University of Georgia
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10
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Strauss GP, Raugh IM, Luther L, Walker EF, Mittal VA. Temporal Interactions Between Social Motivation and Behavior In Daily Life Among Individuals at Clinical High-Risk for Psychosis. Schizophr Bull 2023; 49:1150-1160. [PMID: 37467481 PMCID: PMC10483454 DOI: 10.1093/schbul/sbad096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
BACKGROUND AND HYPOTHESES Poor social functioning is common among individuals at clinical high-risk (CHR) for psychosis and is associated with greater likelihood of conversion. Unfortunately, processes contributing to social impairment are unclear, making social functioning difficult to improve via treatment. The current study examined whether abnormalities in social functioning result from aberrant temporal interactions between social motivation and behavior. STUDY DESIGN Participants included 105 individuals at CHR and 62 healthy controls (CN) who completed 6 days of ecological momentary assessment. Multilevel models examined time-lagged interactions between social behavior and motivation. STUDY RESULTS CHR and CN did not differ in social motivation; however, CHR were less likely to interact with family and coworkers and more likely to engage in interactions via phone and text/social media. Autocorrelations indicated that social behavior and motivation were generally consistent across time in CHR and CN groups. Time-lagged analyses indicated that both groups had an increase in social motivation across time when they were alone and a decrease in social motivation across time when they were with others. However, the relative decrease when with others and increase when alone were less robust in CHR than CN, particularly for in-person interactions. Social motivation at time t did not differentially impact social partner or modality at time t+1 in the groups. CONCLUSIONS Findings suggest that social behavior and motivation have different temporal interactions in CHR and CN. Psychosocial interventions may benefit from targeting the frequency of social behavior with specific partners and modalities to change social motivation.
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Affiliation(s)
| | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
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11
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Berglund AM, Raugh IM, Macdonald KI, James SH, Bartolomeo LA, Knippenberg AR, Strauss GP. The effects of the COVID-19 pandemic on hallucinations and delusions in youth at clinical high-risk for psychosis and outpatients with schizophrenia. Eur Arch Psychiatry Clin Neurosci 2023; 273:1329-1338. [PMID: 36680609 PMCID: PMC9862234 DOI: 10.1007/s00406-023-01551-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/09/2023] [Indexed: 01/22/2023]
Abstract
Although the COVID-19 pandemic has had detrimental effects on mental health in the general population, the impact on those with schizophrenia-spectrum disorders has received relatively little attention. Assessing pandemic-related changes in positive symptoms is particularly critical to inform treatment protocols and determine whether fluctuations in hallucinations and delusions are related to telehealth utilization and treatment adherence. In the current longitudinal study, we evaluated changes in the frequency of hallucinations and delusions and distress resulting from them across three-time points. Participants included: (1) outpatients with chronic schizophrenia (SZ: n = 32) and healthy controls (CN: n = 31); (2) individuals at clinically high risk for psychosis (CHR: n = 25) and CN (n = 30). A series of questionnaires were administered to assess hallucination and delusion severity, medication adherence, telehealth utilization, and protective factors during the pandemic. While there were no significant increases in the frequency of hallucinations and delusions in SZ and CHR, distress increased from pre-pandemic to early pandemic in both groups and then decreased at the third time point. Additionally, changes in positive symptom severity in SZ were related to psychiatric medication adherence. Findings suggest that positive symptoms are a critical treatment target during the pandemic and that ongoing medication services will be beneficial.
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Affiliation(s)
- Alysia M Berglund
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA, 30602, USA
| | - Ian M Raugh
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA, 30602, USA
| | - Kelsey I Macdonald
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA, 30602, USA
| | - Sydney H James
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA, 30602, USA
| | - Lisa A Bartolomeo
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA, 30602, USA
| | - Anna R Knippenberg
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA, 30602, USA
| | - Gregory P Strauss
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA, 30602, USA.
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12
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Raugh IM, Spilka M, Luther L, Suveg CM, Strauss GP. Ecological Momentary Assessment Of State Fluctuations In Mindfulness And Symptoms In Psychotic Disorders. J Contextual Behav Sci 2023; 29:219-229. [PMID: 37720056 PMCID: PMC10501155 DOI: 10.1016/j.jcbs.2023.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Mindfulness skills are a component of many modern cognitive-behavioral therapies that are used to treat a wide range of disorders, including psychotic disorders. While habitual (i.e., trait) mindfulness is associated with clinical outcomes, the effects of momentary (i.e., state) mindfulness are unclear. This is due in part to previous studies using cross-sectional designs relying on trait self-report questionnaires. Although such approaches are invaluable, they lack temporal specificity to evaluate momentary changes and effects of mindfulness. To address these limitations, the current study used ecological momentary assessment (EMA) to evaluate state levels of two mindfulness skills, acceptance and monitoring, and their association with state fluctuations in symptoms. Participants included individuals with affective and non-affective psychotic disorders (PD; n = 49) and healthy controls (CN; n = 53) who completed six days of EMA. Results indicated that the PD group endorsed lower state acceptance than CN; however, the groups did not significantly differ in monitoring. Further, greater state mindfulness skills in both acceptance and monitoring were associated with greater positive affect, reduced negative affect, and reduced negative symptoms. However, participants with a predominantly affective psychosis presentation showed differential effects compared to those with non-affective presentations. These findings suggest that mindfulness training for people with psychotic disorders may benefit from focusing on improving acceptance in order to improve emotional experience and build on existing monitoring skills. Further, mindfulness based psychosocial interventions may offer a novel means of treating negative symptoms in people with PD, which are currently stalled and largely unresponsive to other treatments.
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Affiliation(s)
- Ian M. Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Michael Spilka
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Cynthia M. Suveg
- Department of Psychology, University of Georgia, Athens, GA, USA
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13
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Strauss GP, Zamani Esfahlani F, Raugh IM, Luther L, Sayama H. Markov chain analysis indicates that positive and negative emotions have abnormal temporal interactions during daily life in schizophrenia. J Psychiatr Res 2023; 164:344-349. [PMID: 37399755 PMCID: PMC10389280 DOI: 10.1016/j.jpsychires.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 05/30/2023] [Accepted: 06/21/2023] [Indexed: 07/05/2023]
Abstract
Abnormalities in positive and negative emotional experience have been identified in laboratory-based studies in schizophrenia (SZ) and associated with poorer clinical outcomes. However, emotions are not static in daily life-they are dynamic processes that unfold across time and are characterized by temporal interactions. Whether these temporal interactions are abnormal in SZ and associated with clinical outcomes is unclear (i.e., whether the experience of positive/negative emotions at time t increases or decreases the intensity of positive/negative emotions at time t+1). In the current study, participants with SZ (n = 48) and healthy controls (CN; n = 52) completed 6 days of ecological momentary assessment (EMA) surveys that sampled state emotional experience and symptoms. The EMA emotional experience data was submitted to Markov chain analysis to evaluate transitions among combined positive and negative affective states from time t to t+1. Results indicated that: (1) In SZ, the emotion system is more likely to stay in moderate or high negative affect states, regardless of positive affect level; (2) SZ transition to co-activated emotional states more than CN, and once emotional co-activation occurs, the range of emotional states SZ transition to is more variable than CN; (3) Maladaptive transitions among emotional states were significantly correlated with greater positive symptoms and poorer functional outcome in SZ. Collectively, these findings clarify how emotional co-activation occurs in SZ and its effects on the emotion system across time, as well as how negative emotions dampen the ability to sustain positive emotions across time. Treatment implications are discussed.
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Affiliation(s)
| | | | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Hiroki Sayama
- Departments of Systems Science and Industrial Engineering, Binghamton University, Binghamton, NY, USA
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Raugh IM, Luther L, Bartolomeo LA, Gupta T, Ristanovic I, Pelletier-Baldelli A, Mittal VA, Walker EF, Strauss GP. Negative Symptom Inventory-Self-Report (NSI-SR): Initial development and validation. Schizophr Res 2023; 256:79-87. [PMID: 37172500 PMCID: PMC10262695 DOI: 10.1016/j.schres.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/13/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023]
Abstract
Negative symptoms (i.e., anhedonia, avolition, asociality, blunted affect, alogia) are frequently observed in the schizophrenia-spectrum (SZ) and associated with functional disability. While semi-structured interviews of negative symptoms represent a gold-standard approach, they require specialized training and may be vulnerable to rater biases. Thus, brief self-report questionnaires measuring negative symptoms may be useful. Existing negative symptom questionnaires demonstrate that this approach may be promising in schizophrenia, but no measure has been devised for use across stages of psychotic illness. The present study reports initial psychometric validation of the Negative Symptom Inventory-Self-Report (NSI-SR), the self-report counterpart of the Negative Symptom Inventory-Psychosis Risk clinical interview. The NSI-SR is a novel transphasic negative symptoms measure assessing the domains of anhedonia, avolition, and asociality. The NSI-SR and related measures were administered to two samples: 1) undergraduates (n = 335), 2) community participants, including: SZ (n = 32), clinical-high risk for psychosis (CHR, n = 25), and healthy controls matched to SZ (n = 31) and CHR (n = 30). The psychometrically trimmed 11-item NSI-SR showed good internal consistency and a three-factor solution reflecting avolition, asociality, and anhedonia. The NSI-SR demonstrated convergent validity via moderate to large correlations with clinician-rated negative symptoms and related constructs in both samples. Discriminant validity was supported by lower correlations with positive symptoms in both samples; however, correlations with positive symptoms were still significant. These initial psychometric findings suggest that the NSI-SR is a reliable and valid brief questionnaire capable of measuring negative symptoms across phases of psychotic illness.
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Affiliation(s)
- Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA, USA
| | | | - Tina Gupta
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Ivanka Ristanovic
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | | | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
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15
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Luther L, Raugh IM, Collins DE, Knippenberg AR, Strauss GP. Negative symptoms in schizophrenia differ across environmental contexts in daily life. J Psychiatr Res 2023; 161:10-18. [PMID: 36893666 PMCID: PMC10149609 DOI: 10.1016/j.jpsychires.2023.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/23/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
A recent environmental theory of negative symptoms posits that environmental contexts (e.g., location, social partner) play a significant-yet often unaccounted for-role in negative symptoms of schizophrenia (SZ). "Gold-standard" clinical rating scales offer limited precision for evaluating how contexts impact symptoms. To overcome some of these limitations, Ecological Momentary Assessment (EMA) was used to determine whether there were state fluctuations in experiential negative symptoms (anhedonia, avolition, and asociality) in SZ across contexts (locations, activities, social interaction partner, social interaction method). Outpatients with SZ (n = 52) and healthy controls (CN: n = 55) completed 8 daily EMA surveys for 6 days assessing negative symptom domains (anhedonia, avolition, and asociality) and contexts. Multilevel modeling demonstrated that negative symptoms varied across location, activity, social interaction partner, and social interaction method. For the majority of contexts, SZ and CN did not report significantly different levels of negative symptoms, with SZ only reporting higher negative symptoms than CN while eating, resting, interacting with a significant other, or being at home. Further, there were several contexts where negative symptoms were similarly reduced (e.g., recreation, most social interactions) or elevated (e.g., using the computer, working, running errands) in each group. Results demonstrate that experiential negative symptoms dynamically change across contexts in SZ. Some contexts may "normalize" experiential negative symptoms in SZ, while other contexts, notably some used to promote functional recovery, may increase experiential negative symptoms.
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Affiliation(s)
- Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA, USA.
| | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
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16
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Berglund AM, James SH, Raugh IM, Strauss GP. Beliefs About the Uncontrollability and Usefulness of Emotion in the Schizophrenia-Spectrum: Links to Emotion Regulation and Negative Symptoms. Cognit Ther Res 2023; 47:282-294. [PMID: 36779179 PMCID: PMC9894745 DOI: 10.1007/s10608-023-10357-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2023] [Indexed: 02/05/2023]
Abstract
Background Beliefs about the usefulness and controllability of emotions are associated with emotion regulation and psychological distress in the general population. Although individuals with schizophrenia-spectrum disorders evidence emotion regulation abnormalities, it is unclear whether emotional beliefs contribute to these difficulties and their associated poor clinical outcomes. Methods Participants included 72 individuals with schizophrenia-spectrum diagnoses (outpatients with schizophrenia n = 38; youth at clinical high-risk for psychosis, n = 34) and healthy controls (CN: n = 61) who completed the Emotional Beliefs Questionnaire, Emotion Regulation Questionnaire, and measures of clinical symptom severity. Results Those with schizophrenia-spectrum diagnoses reported believing that emotions were less controllable than CN; however, groups did not differ regarding beliefs about the usefulness of emotion. Greater beliefs of the uncontrollability of emotion were associated with greater use of suppression, less use of reappraisal, and increased negative symptoms. Emotion regulation partially mediated the association between emotional beliefs and negative symptoms. Conclusions Individuals in the schizophrenia-spectrum display superordinate beliefs that emotions are uncontrollable. These beliefs may influence emotion regulation strategy selection and success, which contributes to negative symptoms. Findings suggest that beliefs of emotional uncontrollability reflect a novel process related to both emotion regulation and negative symptoms that could be targeted in psychosocial treatments. Supplementary Information The online version contains supplementary material available at 10.1007/s10608-023-10357-w.
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Affiliation(s)
- Alysia M. Berglund
- Department of Psychology, University of Georgia, 125 Baldwin St, Athens, GA USA
| | - Sydney H. James
- Department of Psychology, University of Georgia, 125 Baldwin St, Athens, GA USA
| | - Ian M. Raugh
- Department of Psychology, University of Georgia, 125 Baldwin St, Athens, GA USA
| | - Gregory P. Strauss
- Department of Psychology, University of Georgia, 125 Baldwin St, Athens, GA USA
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Bartolomeo LA, Raugh IM, Strauss GP. The positivity offset theory of anhedonia in schizophrenia: evidence for a deficit in daily life using digital phenotyping. Psychol Med 2023; 53:1-9. [PMID: 36722014 PMCID: PMC10600929 DOI: 10.1017/s0033291722003774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/11/2022] [Accepted: 11/28/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Negative symptoms of schizophrenia have recently been proposed to result from a decoupling of (intact) hedonic experience and (diminished) approach behavior. The current study challenged this view by exploring the hypothesis that negative symptoms are driven by a specific type of emotional experience abnormality, a reduction in the positivity offset (i.e. the tendency to experience greater levels of positive relative to negative emotion in low-arousal contexts), which limits the production of approach behaviors in neutral environments. METHODS Participants included outpatients with SZ (n = 44) and healthy controls (CN: n = 48) who completed one week of active (ecological momentary assessment surveys of emotional experience and symptoms) and passive (geolocation, accelerometry) digital phenotyping. Mathematical modeling approaches from Cacioppo's Evaluative Space Model were used to quantify the positivity offset in daily life. Negative symptoms were assessed via standard clinical ratings, as well as active (EMA surveys) and passive (geolocation, accelerometry) digital phenotyping measures. RESULTS Results indicated that the positivity offset was reduced in SZ and associated with more severe anhedonia and avolition measured via clinical interviews and active and passive digital phenotyping. CONCLUSIONS These findings suggest that current conceptual models of negative symptoms, which assume hedonic normality, may need to be revised to account for reductions in the positivity offset and its connection to diminished motivated behavior. Findings identify key real-world contexts where negative symptoms could be targeted using psychosocial treatments.
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Affiliation(s)
| | - Ian M. Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
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18
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Tran T, Spilka MJ, Raugh IM, Strauss GP, Bearden CE, Cadenhead KS, Cannon TD, Cornblatt BA, Keshavan M, Mathalon DH, McGlashan TH, Perkins DO, Seidman LJ, Stone WS, Tsuang MT, Walker EF, Woods SW, Addington JM. Negative Symptom Trajectories in Individuals at Clinical High Risk for Psychosis: Differences Based on Deficit Syndrome, Persistence, and Transition Status. Schizophr Bull Open 2023; 4:sgad014. [PMID: 37362552 PMCID: PMC10287168 DOI: 10.1093/schizbullopen/sgad014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Background and Hypothesis Negative symptom trajectory in clinical high risk (CHR) for psychosis is ill defined. This study aimed to better characterize longitudinal patterns of change in negative symptoms, moderators of change, and differences in trajectories according to clinical subgroups. We hypothesized that negative symptom course will be nonlinear in CHR. Clinical subgroups known to be more severe variants of psychotic illness-deficit syndrome (DS), persistent negative syndrome (PNS), and acute psychosis onset-were expected to show more severe baseline symptoms, slower rates of change, and less stable rates of symptom resolution. Study Design Linear, curvilinear, and stepwise growth curve models, with and without moderators, were fitted to negative symptom ratings from the NAPLS-3 CHR dataset (N = 699) and within clinical subgroups. Study Results Negative symptoms followed a downward curvilinear trend, with marked improvement 0-6 months that subsequently stabilized (6-24 months), particularly among those with lower IQ and functioning. Clinical subgroups had higher baseline ratings, but distinct symptom courses; DS vs non-DS: more rapid initial improvement, similar stability of improvements; PNS vs non-PNS: similar rates of initial improvement and stability; transition vs no transition: slower rate of initial improvement, with greater stability of this rate. Conclusions Continuous, frequent monitoring of negative symptoms in CHR is justified by 2 important study implications: (1) The initial 6 months of CHR program enrollment may be a key window for improving negative symptoms as less improvement is likely afterwards, (2) Early identification of clinical subgroups may inform distinct negative symptom trajectories and treatment needs.
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Affiliation(s)
- Tanya Tran
- Department of Psychology, Queen’s University, Kingston, ON, Canada
| | - Michael J Spilka
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
| | | | - Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| | | | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, CT, USA
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | | | - Matcheri Keshavan
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, USA
| | - Daniel H Mathalon
- Department of Psychiatry, UCSF, and SFVA Medical Center, San Francisco, CA, USA
| | | | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, USA
| | - William S Stone
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, USA
| | - Ming T Tsuang
- Department of Psychiatry, UCSD, San Diego, CA, USA
- Institute of Genomic Medicine, University of California, La Jolla, CA, USA
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
- Department of Psychiatry, Emory University, Atlanta, GA, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Jean M Addington
- To whom correspondence should be addressed; Department of Psychiatry, Hotchkiss Brain Institute, Mathison Centre for Mental Health Research & Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; fax: (403) 210-9114; e-mail:
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Raugh IM, Strauss GP. Deconstructing emotion regulation in schizophrenia: the nature and consequences of abnormalities at the identification stage. Eur Arch Psychiatry Clin Neurosci 2022; 272:1061-1071. [PMID: 34716486 DOI: 10.1007/s00406-021-01350-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 10/19/2021] [Indexed: 02/06/2023]
Abstract
Existing evidence suggests that emotion regulation is abnormal in schizophrenia and associated with undesirable clinical outcomes. However, this literature is based predominantly on trait self-report and does not indicate which stages of emotion regulation (identification, selection, implementation) are impaired. The current study focused on determining the nature of abnormalities at the identification stage using ecological momentary assessment (EMA). Participants included clinically stable outpatients with schizophrenia (SZ; n = 48) and healthy controls (CN; n = 52) who completed 6 days of EMA. The EMA surveys assessed emotional experience, emotion regulation, and symptoms. Results indicated that SZ identified the need to regulate at a higher rate than CN. Specifically, SZ displayed an inefficient threshold for identifying the need to regulate, such that they regulated too much when negative affect was low and too little when negative affect was high. Emotion regulation effort exertion was also inefficient, such that effort was too high at low levels of negative affect and too low at high levels of negative affect in SZ. These identification stage abnormalities also demonstrated differential associations with positive and negative symptoms. Findings suggest that identification stage abnormalities may create a bottleneck that feeds forward and impacts subsequent stages of emotion regulation in SZ that are critically related to symptoms. Targeting the psychological processes underlying these identification stage abnormalities might offer a novel means of treating positive and negative symptoms in schizophrenia.
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Affiliation(s)
- Ian M Raugh
- Department of Psychology, University of Georgia, 125 Baldwin St, Athens, GA, 30602, USA
| | - Gregory P Strauss
- Department of Psychology, University of Georgia, 125 Baldwin St, Athens, GA, 30602, USA.
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20
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Collins DE, Luther L, Raugh IM, Condray R, Allen DN, Strauss GP. The Role of Disability Benefits as an Environmental Factor Contributing to Negative Symptoms. Schizophr Bull 2022; 49:1-4. [PMID: 35808961 PMCID: PMC9810000 DOI: 10.1093/schbul/sbac077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
| | - Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Ruth Condray
- Biometrics Research Program, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Daniel N Allen
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Gregory P Strauss
- To whom correspondence should be addressed; Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA 30602; tel: +1-706-542-0307, fax: +1-706-542-3275,
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21
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Miller ML, Raugh IM, Strauss GP, Harvey PD. Remote digital phenotyping in serious mental illness: Focus on negative symptoms, mood symptoms, and self-awareness. Biomark Neuropsychiatry 2022. [DOI: 10.1016/j.bionps.2022.100047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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22
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Cowan T, Strauss GP, Raugh IM, Le TP, Cohen AS. How do social factors relate to blunted facial affect in schizophrenia? A digital phenotyping study using ambulatory video recordings. J Psychiatr Res 2022; 150:96-104. [PMID: 35366600 PMCID: PMC10036138 DOI: 10.1016/j.jpsychires.2022.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 03/09/2022] [Accepted: 03/21/2022] [Indexed: 01/05/2023]
Abstract
Clinical interviews and laboratory-based emotional induction paradigms provide consistent evidence that facial affect is blunted in many individuals with schizophrenia. Although it is clear that blunted facial affect is not a by-product of diminished emotional experience in schizophrenia, factors contributing to blunted affect remain unclear. The current study used a combination of ambulatory video recordings that were evaluated via computerized facial affect analysis and concurrently completed ecological momentary assessment surveys to assess whether blunted affect reflects insufficient reactivity to affective or contextual factors. Specifically, whether individuals with schizophrenia require more intense affective experiences to produce expression, or whether they are less reactive to social factors (i.e. being in the presence of others, social motivation). Participants included outpatients with schizophrenia (n = 33) and healthy controls (n = 31) who completed six days of study procedures. Multilevel linear models were evaluated using both Null-Hypothesis Statistical Testing and Bayesian analyses. Individuals with schizophrenia displayed comparable expression of positive and negative emotion to controls during daily life, and no evidence was found for a different intensity of experience required for expression in either group. However, social factors differentially influenced facial expression in schizophrenia compared to controls, such that individuals with schizophrenia did not modulate their expressions based on social motivation to the same extent as controls. These findings suggest that social motivation may play an important role in determining when blunting occurs.
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Affiliation(s)
- Tovah Cowan
- Department of Psychology, Louisiana State University, United States; Center for Computation and Technology, Louisiana State University, United States
| | | | - Ian M Raugh
- Department of Psychology, University of Georgia, United States
| | - Thanh P Le
- Department of Psychology, Louisiana State University, United States
| | - Alex S Cohen
- Department of Psychology, Louisiana State University, United States; Center for Computation and Technology, Louisiana State University, United States.
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23
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Macdonald KI, Spilka MJ, Bartolomeo LA, Raugh IM, Berglund AM, Strauss GP. Adherence to recommended health and social distancing precautions during the COVID-19 pandemic in individuals with schizophrenia and youth at clinical high-risk for psychosis. Schizophr Res 2022; 243:446-448. [PMID: 34334286 PMCID: PMC8321773 DOI: 10.1016/j.schres.2021.07.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 11/23/2022]
Affiliation(s)
| | | | | | | | | | - Gregory P. Strauss
- Corresponding author at: University of Georgia, Department of Psychology, 125 Baldwin St., Athens, GA 30602, USA
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24
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Cowan T, Cohen AS, Raugh IM, Strauss GP. Ambulatory audio and video recording for digital phenotyping in schizophrenia: Adherence & data usability. Psychiatry Res 2022; 311:114485. [PMID: 35276573 PMCID: PMC9018573 DOI: 10.1016/j.psychres.2022.114485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 12/18/2022]
Abstract
Ambulatory audio and video recording provides a wealth of information which can be used for a broad range of applications, including digital phenotyping, telepsychiatry, and telepsychology. However, these technologies are in their infancy, and guidelines for their use and analysis have yet to be established. The current project used ambulatory assessment data from individuals with schizophrenia (N = 52) and controls (N = 55) over a week to assess factors influencing sufficiency and useability of video and audio data. Logistic multilevel models examined the effect of relevant variables on video provision and video quality. There was no difference by group in video provision or quality. Videos were less likely to be provided later in the study and later in the day. Video quality was lower later in the day, particularly for controls. Participants were more likely to provide videos if alone or at home than in other settings. Black participants were less likely to have analyzable video frames than White participants. These results suggest potential racial disparities in camera technologies and/or facial analysis algorithms. Implications of these findings and recommendations for future study development, such as instructions to provide to participants to optimize video quality, are discussed.
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Affiliation(s)
- Tovah Cowan
- Department of Psychology, Louisiana State University, Baton Rouge, USA,Center for Computation and Technology, Louisiana State University, Baton Rouge, USA
| | - Alex S. Cohen
- Department of Psychology, Louisiana State University, Baton Rouge, USA,Center for Computation and Technology, Louisiana State University, Baton Rouge, USA
| | - Ian M. Raugh
- Department of Psychology, University of Georgia, Athens, USA
| | - Gregory P. Strauss
- Department of Psychology, University of Georgia, Athens, USA,Correspondence concerning this article should be addressed to Gregory P. Strauss, PhD. Department of Psychology, Psychology Building, University of Georgia, Athens, GA 30602-3013,
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25
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Strauss GP, Raugh IM, Zhang L, Luther L, Chapman HC, Allen DN, Kirkpatrick B, Cohen AS. Validation of accelerometry as a digital phenotyping measure of negative symptoms in schizophrenia. Schizophrenia (Heidelb) 2022; 8:37. [PMID: 35853890 PMCID: PMC9261099 DOI: 10.1038/s41537-022-00241-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 02/24/2022] [Indexed: 05/05/2023]
Abstract
Negative symptoms are commonly assessed via clinical rating scales; however, these measures have several inherent limitations that impact validity and utility for their use in clinical trials. Objective digital phenotyping measures that overcome some of these limitations are now available. The current study evaluated the validity of accelerometry (ACL), a passive digital phenotyping method that involves collecting data on the presence, vigor, and variability of movement. Outpatients with schizophrenia (SZ: n = 50) and demographically matched healthy controls (CN: n = 70) had ACL continuously recorded from a smartphone and smartband for 6 days. Active digital phenotyping assessments, including surveys related to activity context, were also collected via 8 daily surveys throughout the 6 day period. SZ participants had lower scores on phone ACL variables reflecting vigor and variability of movement compared to CN. ACL variables demonstrated convergent validity as indicated by significant correlations with active digital phenotyping self-reports of time spent in goal-directed activities and clinical ratings of negative symptoms. The discriminant validity of ACL was demonstrated by low correlations with clinical rating scale measures of positive, disorganized, and total symptoms. Collectively, findings suggest that ACL is a valid objective measure of negative symptoms that may complement traditional approaches to assessing the construct using clinical rating scales.
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Affiliation(s)
| | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Luyu Zhang
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Hannah C Chapman
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Daniel N Allen
- Department of Psychology, University of Nevada, Las Vegas, NV, USA
| | - Brian Kirkpatrick
- Department of Psychiatry and Behavioral Sciences, University of Nevada, Reno School of Medicine, Las Vegas, NV, USA
| | - Alex S Cohen
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
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26
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Tran T, Holland AH, Zhang L, Raugh IM, Strauss GP. Letter to the Editor: Social media and internet use is associated with both adaptive and maladaptive changes in mental health during the COVID-19 pandemic in youth at clinical high-risk for psychosis. J Psychiatr Res 2022; 147:1-3. [PMID: 34998219 DOI: 10.1016/j.jpsychires.2021.12.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Tanya Tran
- Department of Psychology, Humphrey Hall, 62 Arch St, Queen's University, Kingston, ON, K7L 3L3, Canada
| | - Alexis H Holland
- Department of Psychology, 125 Baldwin St, University of Georgia, Athens, GA, USA, 30602
| | - Luyu Zhang
- Department of Psychology, 125 Baldwin St, University of Georgia, Athens, GA, USA, 30602
| | - Ian M Raugh
- Department of Psychology, 125 Baldwin St, University of Georgia, Athens, GA, USA, 30602
| | - Gregory P Strauss
- Department of Psychology, 125 Baldwin St, University of Georgia, Athens, GA, USA, 30602.
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27
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Narkhede SM, Luther L, Raugh IM, Knippenberg AR, Esfahlani FZ, Sayama H, Cohen AS, Kirkpatrick B, Strauss GP. Machine Learning Identifies Digital Phenotyping Measures Most Relevant to Negative Symptoms in Psychotic Disorders: Implications for Clinical Trials. Schizophr Bull 2022; 48:425-436. [PMID: 34915570 PMCID: PMC8886590 DOI: 10.1093/schbul/sbab134] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Digital phenotyping has been proposed as a novel assessment tool for clinical trials targeting negative symptoms in psychotic disorders (PDs). However, it is unclear which digital phenotyping measurements are most appropriate for this purpose. AIMS Machine learning was used to address this gap in the literature and determine whether: (1) diagnostic status could be classified from digital phenotyping measures relevant to negative symptoms and (2) the 5 negative symptom domains (anhedonia, avolition, asociality, alogia, and blunted affect) were differentially classified by active and passive digital phenotyping variables. METHODS Participants included 52 outpatients with a PD and 55 healthy controls (CN) who completed 6 days of active (ecological momentary assessment surveys) and passive (geolocation, accelerometry) digital phenotyping data along with clinical ratings of negative symptoms. RESULTS Machine learning algorithms classifying the presence of a PD diagnosis yielded 80% accuracy for cross-validation in H2O AutoML and 79% test accuracy in the Recursive Feature Elimination with Cross Validation feature selection model. Models classifying the presence vs absence of clinically significant elevations on each of the 5 negative symptom domains ranged in test accuracy from 73% to 91%. A few active and passive features were highly predictive of all 5 negative symptom domains; however, there were also unique predictors for each domain. CONCLUSIONS These findings suggest that negative symptoms can be modeled from digital phenotyping data recorded in situ. Implications for selecting the most appropriate digital phenotyping variables for use as outcome measures in clinical trials targeting negative symptoms are discussed.
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Affiliation(s)
- Sayli M Narkhede
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
| | | | | | - Hiroki Sayama
- Department of Systems Science and Industrial Engineering, Binghamton University, Binghamton, NY, USA
| | - Alex S Cohen
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Brian Kirkpatrick
- Department of Psychiatry, University of Nevada, Reno School of Medicine, Reno, NV, USA
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Bartolomeo LA, Raugh IM, Strauss GP. Deconstructing emotion regulation in schizophrenia: The nature and consequences of abnormalities in monitoring dynamics. Schizophr Res 2022; 240:135-142. [PMID: 35026598 PMCID: PMC8917994 DOI: 10.1016/j.schres.2021.12.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 11/09/2021] [Accepted: 12/25/2021] [Indexed: 02/03/2023]
Abstract
Prior studies implicate abnormalities at the identification, selection, and implementation stages of Gross' extended process model of emotion regulation in schizophrenia. However, it is unclear whether monitoring dynamics (i.e., emotion regulation maintenance, switching, and stopping), another critical component of the model, are also abnormal or what predicts those abnormalities. The current study evaluated switching (i.e., switching to a different emotion regulation strategy because the initial strategy was not effective) and stopping dynamics (i.e., terminating the implementation of an emotion regulation strategy) and their associated mechanisms using 6 days of ecological momentary assessment in 47 outpatients with schizophrenia or schizoaffective disorder (SZ) and 52 healthy controls (CN). Results indicated that individuals with SZ exhibited excessive switching between emotion regulation strategies and delayed stopping compared to CN, self-efficacy moderated group differences in stopping abnormalities, and switching and stopping abnormalities were associated with different patterns of state-level positive and negative symptoms in SZ. Findings may inform psychosocial emotion regulation therapies for SZ that could incorporate elements for monitoring dynamics and associated mechanisms.
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Affiliation(s)
| | - Ian M Raugh
- Department of Psychology, University of Georgia, United States
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Abstract
BACKGROUND Schizophrenia (SZ) is typically preceded by a prodromal (i.e. pre-illness) period characterized by attenuated positive symptoms and declining functional outcome. Negative symptoms are prominent among individuals at clinical high-risk (CHR) for psychosis (i.e. those with prodromal syndromes) and highly predictive of conversion to illness. Mechanisms underlying negative symptoms in the CHR population are unclear. Two studies were conducted to evaluate whether abnormalities in a reward processing mechanism thought to be core to negative symptoms in SZ, value representation, also exist in CHR individuals and whether they are associated with negative symptoms transphasically. METHODS Study 1 included 33 individuals in the chronic phase of illness who have been diagnosed with schizophrenia or schizoaffective disorder (SZ) and 40 healthy controls (CN). Study 2 included 37 CHR participants and 45 CN. In both studies, participants completed the delay discounting (DD) task as a measure of value representation and the Brief Negative Symptom Scale was rated to measure negative symptoms. RESULTS Results indicated that patients with SZ had steeper discounting rates than CN, indicating impairments in value representation. However, CHR participants were unimpaired on the DD task. In both studies, steeper discounting was associated with greater severity of negative symptoms. CONCLUSIONS These findings suggest that deficits in value representation are associated with negative symptoms transphasically.
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Affiliation(s)
| | | | - Ian M Raugh
- Department of Psychology, University of Georgia, USA
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Clay KB, Raugh IM, Bartolomeo LA, Strauss GP. Defeatist performance beliefs in individuals at clinical high-risk for psychosis and outpatients with chronic schizophrenia. Early Interv Psychiatry 2021; 15:865-873. [PMID: 32743974 DOI: 10.1111/eip.13024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 12/29/2022]
Abstract
AIM Prior studies indicate that defeatist performance beliefs (DPBs) are elevated in those in the chronic phase of schizophrenia (SZ) and associated with negative symptoms, functional outcome and neurocognitive impairment. However, it is unclear whether these same patterns of results hold in participants at clinical high-risk (CHR) for psychosis. METHODS Two studies were conducted to determine whether prior results in SZ could be replicated and extended to CHR. Participants included 184 healthy controls (CN) and 186 outpatients with chronic SZ for Study 1, and 30 CN and 35 CHR in Study 2. In both studies, participants completed the DPB scale and measures of negative symptoms, psychosocial functioning and neurocognition. RESULTS Both chronic SZ and CHR participants had elevated DPBs compared to CN (p's < .01). In SZ, higher DPBs were associated with greater negative symptoms (r's = .31-.37, p's < .01), poorer social functioning and impaired social cognition (r = -.40, P < .001). In CHR, greater DPBs were associated with poorer social functioning (r = -.52, P < .05) and impairments in the neurocognitive domains of reasoning (r = -.48, P < .05) and processing speed (r = -.41, P < .05). Models testing whether DPBs mediated links between negative symptoms and functioning, negative symptoms and cognition and cognition and functioning were nonsignificant in SZ and CHR samples. CONCLUSIONS Findings generally provide support for the cognitive model of negative symptoms and functioning and suggest that DPBs are an important clinical target across phases of psychotic illness.
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Affiliation(s)
- Kendall B Clay
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Lisa A Bartolomeo
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Gregory P Strauss
- Department of Psychology, University of Georgia, Athens, Georgia, USA
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31
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Raugh IM, James SH, Gonzalez CM, Chapman HC, Cohen AS, Kirkpatrick B, Strauss GP. Digital phenotyping adherence, feasibility, and tolerability in outpatients with schizophrenia. J Psychiatr Res 2021; 138:436-443. [PMID: 33964681 PMCID: PMC8192468 DOI: 10.1016/j.jpsychires.2021.04.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/19/2021] [Accepted: 04/25/2021] [Indexed: 11/25/2022]
Abstract
Digital phenotyping has potential for use as an objective and ecologically valid form of symptom assessment in clinical trials for schizophrenia. However, there are critical methodological factors that must be addressed before digital phenotyping can be used for this purpose. The current study evaluated levels of adherence, feasibility, and tolerability for active (i.e., signal and event contingent ecological momentary assessment surveys) and passive (i.e., geolocation, accelerometry, and ambulatory psychophysiology) digital phenotyping methods recorded from smartphone and smartband devices. Participants included outpatients diagnosed with schizophrenia (SZ: n = 54) and demographically matched healthy controls (CN: n = 55), who completed 6 days of digital phenotyping. Adherence was significantly lower in SZ than CN for active recordings, but not markedly different for passive recordings. Some forms of passive recordings had lower adherence (ambulatory psychophysiology) than others (accelerometry and geolocation). Active digital phenotyping adherence was predicted by higher psychosocial functioning, whereas passive digital phenotyping adherence was predicted by education, positive symptoms, negative symptoms, and psychosocial functioning in people with SZ. Both groups found digital phenotyping methods tolerable and feasibility was supported by low frequency of invalid responding, brief survey completion times, and similar impediments to study completion. Digital phenotyping methods can be completed by individuals with SZ with good adherence, feasibility, and tolerability. Recommendations are provided for using digital phenotyping methods in clinical trials for SZ.
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Affiliation(s)
- Ian M. Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Sydney H. James
- Department of Psychology, University of Georgia, Athens, GA, USA
| | | | | | - Alex S. Cohen
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Brian Kirkpatrick
- Department of Psychiatry and Behavioral Sciences, University of Nevada, Reno School of Medicine, Reno, NV, USA
| | - Gregory P. Strauss
- Department of Psychology, University of Georgia, Athens, GA, USA,Correspondence concerning this article should be addressed to Gregory P. Strauss, Ph.D., . Phone: +1-706-542-0307. Fax: +1-706-542-3275. University of Georgia, Department of Psychology, 125 Baldwin St., Athens, GA 30602
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Raugh IM, James SH, Gonzalez CM, Chapman HC, Cohen AS, Kirkpatrick B, Strauss GP. Geolocation as a Digital Phenotyping Measure of Negative Symptoms and Functional Outcome. Schizophr Bull 2020; 46:1596-1607. [PMID: 32851401 PMCID: PMC7751192 DOI: 10.1093/schbul/sbaa121] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Negative symptoms and functional outcome have traditionally been assessed using clinical rating scales, which rely on retrospective self-reports and have several inherent limitations that impact validity. These issues may be addressed with more objective digital phenotyping measures. In the current study, we evaluated the psychometric properties of a novel "passive" digital phenotyping method: geolocation. METHOD Participants included outpatients with schizophrenia or schizoaffective disorder (SZ: n = 44), outpatients with bipolar disorder (BD: n =19), and demographically matched healthy controls (CN: n = 42) who completed 6 days of "active" digital phenotyping assessments (eg, surveys) while geolocation was recorded. RESULTS Results indicated that SZ patients show less activity than CN and BD, particularly, in their travel from home. Geolocation variables demonstrated convergent validity by small to medium correlations with negative symptoms and functional outcome measured via clinical rating scales, as well as active digital phenotyping behavioral indices of avolition, asociality, and anhedonia. Discriminant validity was supported by low correlations with positive symptoms, depression, and anxiety. Reliability was supported by good internal consistency and moderate stability across days. CONCLUSIONS These findings provide preliminary support for the reliability and validity of geolocation as an objective measure of negative symptoms and functional outcome. Geolocation offers enhanced precision and the ability to take a "big data" approach that facilitates sophisticated computational models. Near-continuous recordings and large numbers of samples may make geolocation a novel outcome measure for clinical trials due to enhanced power to detect treatment effects.
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Affiliation(s)
- Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA
| | - Sydney H James
- Department of Psychology, University of Georgia, Athens, GA
| | | | | | - Alex S Cohen
- Department of Psychology, Louisiana State University, Baton Rouge, LA
| | - Brian Kirkpatrick
- Department of Psychiatry and Behavioral Sciences, University of Nevada, Reno School of Medicine, Reno, NV
| | - Gregory P Strauss
- Department of Psychology, University of Georgia, Athens, GA,To whom correspondence should be addressed; tel: +1-706-542-0307, fax: +1-706-542-3275, e-mail:
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Cohen AS, Cowan T, Le TP, Schwartz EK, Kirkpatrick B, Raugh IM, Chapman HC, Strauss GP. Ambulatory digital phenotyping of blunted affect and alogia using objective facial and vocal analysis: Proof of concept. Schizophr Res 2020; 220:141-146. [PMID: 32247747 PMCID: PMC7306442 DOI: 10.1016/j.schres.2020.03.043] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 01/10/2020] [Accepted: 03/21/2020] [Indexed: 11/28/2022]
Abstract
Negative symptoms reflect one of the most debilitating aspects of one of the most debilitating diseases known to humankind. As yet, our treatments for negative symptoms are palliative at best and our understanding of their causes is relatively superficial. To address this, we are developing objective ambulatory tools for digitally phenotyping their severity which can be used outside the confines of the traditional clinical and research settings. The present study evaluated the feasibility, reliability and validity of ambulatory vocal acoustic and facial emotion expression analysis. Videos were provided by 25 patients with schizophrenia or schizoaffective disorder and 27 nonpsychiatric controls using inexpensive, non-invasive ambulatory recording methods. Controls provided 411 video recordings, and patients provided 377 video recordings; an average of 15.22 and 14.50 per participant per group respectively. The vast majority (over 80%) of these videos were usable for analysis. An empirically-supported, limited-feature vocal (7 features) and facial (3 features) set was examined. Within participants, these features varied considerably over time, but showed moderate to good test-retest reliability in many cases once contextual factors (e.g., activity involved in at the time of testing) were accounted for. Vocal and facial features showed statistically significant convergence with a "gold standard" negative symptom measure. Ambulatory vocal/facial features were more strongly associated with engagement in social or work activities in patients than negative symptom ratings. These data support the use of ambulatory vocal/facial analytic technologies for digital phenotyping of these negative symptoms.
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Affiliation(s)
- Alex S. Cohen
- Louisiana State University, Department of Psychology, 236 Audubon Hall, Louisiana State University, Baton Rouge, LA, USA, 70803
| | - Tovah Cowan
- Louisiana State University, Department of Psychology, 236 Audubon Hall, Louisiana State University, Baton Rouge, LA, USA, 70803
| | - Thanh P. Le
- Louisiana State University, Department of Psychology, 236 Audubon Hall, Louisiana State University, Baton Rouge, LA, USA, 70803
| | - Elana K. Schwartz
- Louisiana State University, Department of Psychology, 236 Audubon Hall, Louisiana State University, Baton Rouge, LA, USA, 70803
| | - Brian Kirkpatrick
- University of Nevada, Reno School of Medicine, Psychiatry & Behavioral Sciences, 5190 Neil Rd #215, Reno, NV, USA, 89502
| | - Ian M. Raugh
- University of Georgia, Department of Psychology, 125 Baldwin St, Athens, GA, USA, 30602
| | - Hannah C. Chapman
- University of Georgia, Department of Psychology, 125 Baldwin St, Athens, GA, USA, 30602
| | - Gregory P. Strauss
- University of Georgia, Department of Psychology, 125 Baldwin St, Athens, GA, USA, 30602
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Abstract
Negative symptoms are a critical, but poorly understood, aspect of schizophrenia. Measurement of negative symptoms primarily relies on clinician ratings, an endeavor with established reliability and validity. There have been increasing attempts to digitally phenotype negative symptoms using objective biobehavioral technologies, eg, using computerized analysis of vocal, speech, facial, hand and other behaviors. Surprisingly, biobehavioral technologies and clinician ratings are only modestly inter-related, and findings from individual studies often do not replicate or are counterintuitive. In this article, we document and evaluate this lack of convergence in 4 case studies, in an archival dataset of 877 audio/video samples, and in the extant literature. We then explain this divergence in terms of "resolution"-a critical psychometric property in biomedical, engineering, and computational sciences defined as precision in distinguishing various aspects of a signal. We demonstrate how convergence between clinical ratings and biobehavioral data can be achieved by scaling data across various resolutions. Clinical ratings reflect an indispensable tool that integrates considerable information into actionable, yet "low resolution" ordinal ratings. This allows viewing of the "forest" of negative symptoms. Unfortunately, their resolution cannot be scaled or decomposed with sufficient precision to isolate the time, setting, and nature of negative symptoms for many purposes (ie, to see the "trees"). Biobehavioral measures afford precision for understanding when, where, and why negative symptoms emerge, though much work is needed to validate them. Digital phenotyping of negative symptoms can provide unprecedented opportunities for tracking, understanding, and treating them, but requires consideration of resolution.
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Affiliation(s)
- Alex S Cohen
- Department of Psychology, Louisiana State University, Baton Rouge, LA,Louisiana State University, Center for Computation and Technology, Baton Rouge, LA,To whom correspondence should be addressed; Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA 70803; tel: +1-225-578-7017, fax: +1-225-578-4125, e-mail:
| | - Elana Schwartz
- Department of Psychology, Louisiana State University, Baton Rouge, LA,Louisiana State University, Center for Computation and Technology, Baton Rouge, LA
| | - Thanh P Le
- Department of Psychology, Louisiana State University, Baton Rouge, LA,Louisiana State University, Center for Computation and Technology, Baton Rouge, LA
| | - Tovah Cowan
- Department of Psychology, Louisiana State University, Baton Rouge, LA,Louisiana State University, Center for Computation and Technology, Baton Rouge, LA
| | - Brian Kirkpatrick
- Department of Psychiatry and Behavioral Sciences, University of Nevada, Reno School of Medicine, Reno, NV
| | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA
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35
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Visser KF, Chapman HC, Ruiz I, Raugh IM, Strauss GP. A meta-analysis of self-reported anticipatory and consummatory pleasure in the schizophrenia-spectrum. J Psychiatr Res 2020; 121:68-81. [PMID: 31783235 PMCID: PMC6939125 DOI: 10.1016/j.jpsychires.2019.11.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 11/03/2019] [Accepted: 11/13/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Recent conceptual frameworks propose anhedonia reflects abnormalities in the temporal dynamics of positive emotion in schizophrenia, characterized by intact consummatory and impaired anticipatory pleasure. A comprehensive meta-analysis can directly test this theory using self-report data. METHOD A meta-analysis was performed on studies reporting Temporal Experience of Pleasure Scale (TEPS) data from healthy controls and schizophrenia or schizotypy groups. The TEPS was examined as it contains subscales to measure both consummatory and anticipatory pleasure separately. Statistical heterogeneity and study bias were examined. Meta-regressions evaluated moderators. RESULTS 53 studies were retrieved (7,797 participants). Results revealed small effect sizes for comparisons of combined schizophrenia/schizotypy and control groups for both consummatory and anticipatory pleasure. Within-group comparisons of pleasure conditions were nonsignificant. The percentage of male schizophrenia/schizotypy participants significantly moderated anticipatory and consummatory pleasure for the combined sample and schizotypy alone; male participants were found to report reduced pleasure. There was only minor evidence of bias; sensitivity analysis confirmed result robustness. Exploratory outlier removal for schizophrenia within-group pleasure comparisons revealed a statistically significant difference between reported anticipatory and consummatory pleasure, with consummatory pleasure reduced relative to anticipatory (i.e., in the opposite direction of the majority of experimental research findings). CONCLUSIONS These findings provided only modest support for the temporal dynamics of positive emotion conceptualization because they revealed no evidence for: 1) specific anticipatory pleasure deficits in schizophrenia-spectrum participants compared to controls; 2) significant reductions in anticipatory pleasure relative to consummatory pleasure in schizophrenia-spectrum participants.
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Affiliation(s)
| | - Hannah C Chapman
- University of Georgia, Department of Psychology, Athens, GA, USA
| | - Ivan Ruiz
- University of Georgia, Department of Psychology, Athens, GA, USA
| | - Ian M Raugh
- University of Georgia, Department of Psychology, Athens, GA, USA
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Raugh IM, Chapman HC, Bartolomeo LA, Gonzalez C, Strauss GP. A comprehensive review of psychophysiological applications for ecological momentary assessment in psychiatric populations. Psychol Assess 2019; 31:304-317. [PMID: 30802116 DOI: 10.1037/pas0000651] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Psychophysiological assessment is a core method used in psychopathology research that has led to important insights in relation to the etiology and maintenance of many disorders. However, laboratory psychophysiology has limited ecological validity. This limitation has resulted in the field moving toward ambulatory recordings of psychophysiology paired with ecological momentary assessment (EMA). This review uses the results of a comprehensive review of EMA psychophysiology studies to discuss applications, advantages, limitations, and future use of this methodology, including electrocardiography, blood pressure, electroencephalography, and more. Mobile psychophysiology has several advantages, including ecological validity, temporal precision, and concurrent evaluation of internally and externally generated contexts that influence physiological response. However, it is limited by the difficulty of conducting such studies and reduced experimental control. Future research using EMA psychophysiology should aim to record over longer periods, better integrate with everyday life, determine the utility of ecological momentary interventions based on psychophysiology, create guidelines for standardization, and aim to establish reliability and validity. EMA psychophysiology is a promising direction for the field and provides novel avenues for research and treatment of psychopathology, although methodological shortcomings must be addressed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Ian M Raugh
- Department of Psychology, University of Georgia
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Strauss GP, Raugh IM, Mittal VA, Gibb BE, Coles ME. Bullying victimization and perpetration in a community sample of youth with psychotic like experiences. Schizophr Res 2018; 195:534-536. [PMID: 28888357 DOI: 10.1016/j.schres.2017.08.056] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/23/2017] [Accepted: 08/29/2017] [Indexed: 02/09/2023]
Abstract
Prior studies indicate an association between psychotic-like experiences (PLEs) and bullying victimization; however, the most frequent types of bullying victimization and the association with bullying perpetration are unclear. A community sample of 1563 adolescents completed questionnaires examining PLEs and frequency of bullying victimization and perpetration. Compared to adolescents scoring below the psychosis-risk cut-off (n=1294), those with PLEs (who are putatively at-risk) (n=269) were more likely to report being the victims of overt, relational, and reputational bullying and to have perpetrated bullying against others. Increased bullying perpetration among youth with PLEs may reflect reactive aggression in response to being bullied.
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Affiliation(s)
| | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Brandon E Gibb
- Department of Psychology, Binghamton University, Binghamton, NY, USA
| | - Meredith E Coles
- Department of Psychology, Binghamton University, Binghamton, NY, USA
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