Björn Schlier

The Community Assessment of Psychic Experiences measures nine clusters of psychosis-like experiences: A validation of the German version of the CAPE.

AIM This study examined the factorial and criterion validity of the Community Assessment of Psychic Experiences (CAPE). We compared the validity of the original three-dimensional model and a recently proposed multidimensional model, in which positive symptoms are subdivided into the subfactors hallucinations, bizarre experiences, paranoia, grandiosity and magical thinking and negative symptoms are subdivided into social withdrawal, affective flattening and avolition. METHODS Eleven community (n=934) and three patient samples (n=112) were combined and the proposed models were tested using confirmatory factor analysis. Criterion validity was calculated based on self-report measures for depression and paranoia as well as observer-based ratings for positive and negative symptoms. RESULTS The multidimensional model showed better relative quality (AIC, BIC) than the original three-dimensional model of the CAPE, but both models showed acceptable absolute model-fit (RMSEA, SRMR). The criterion validity was good for the positive symptom scales and negative symptom subfactors social withdrawal and affective flattening. CONCLUSION Factorial validity was found for the three-dimensional and multidimensional model for the CAPE. The multidimensional model, however, shows better comparative fit and promising results in regard to criterion validity. Thus, we recommend a hierarchical multidimensional structure of positive and negative symptoms for future use of the CAPE.

Measuring fluctuations in paranoia: Validity and psychometric properties of brief state versions of the Paranoia Checklist

Research increasingly assesses momentary changes in paranoia in order to elucidate causal mechanisms. Observed or manipulated changes in postulated causal factors should result in fluctuations in state paranoid ideation. Previous studies often employed a state-adapted Paranoia Checklist (Freeman et al., 2005) to measure state paranoia. This study examined whether the Paranoia Checklist or subsets of its items are appropriate for this purpose. Thirteen studies (N=860) were subjected to meta-analyses of each Paranoia Checklist item. We selected items based on (1) whether they showed pre-to-post change in the expected direction and (2) whether this effect was larger in experimental vs. control conditions. All resulting item selections were cross-validated on a hold-out sample (n=1893). Finally, we explored how much variation in paranoia was captured by the state-adapted version in a brief ambulatory assessment study (N=32). A thirteen item State Paranoia Checklist as well as a five item and a three item Brief State Paranoia Checklist were extracted. Cross validation revealed better model fit and increased sensitivity to change. Multilevel analysis indicated 25-30% of the variance in the Brief State Paranoia Checklists to be due to intra-individual daily fluctuations in paranoia. Our analyses produced reliable and valid revised scales. Increases in change sensitivity indicate that future assessment of state paranoia in experimental and ambulatory assessment studies can be optimized by using the revised scales.

Feasibility and Effects of a Brief Compassion‐Focused Imagery Intervention in Psychotic Patients with Paranoid Ideation: A Randomized Experimental Pilot Study

Paranoia is characterized by a lack of perceived social safeness and associated negative affect. Low self-esteem, negative self-concepts and negative emotions have been shown to contribute to paranoid symptom formation. Thus, interventions focusing on affiliation and positive affect might be particularly helpful for patients with paranoia. The present study experimentally tested the effect of a one-session, brief compassion-focused imagery derived from Compassion-Focused Therapy (Gilbert, ) versus a control imagery condition in a repeated measures randomized design. A negative affective state was induced via in-sensu exposure to a recent distressful social situation in order to provide a minimum level of threat-related arousal to be down-regulated by the interventions thereafter. The sample consisted of psychotic patients with paranoid ideation (N = 51) who were randomly assigned to one of the experimental conditions. Effects on postulated causal mechanisms, i.e., self-relating (self-reassurance, self-compassion, self-criticism), and affect (self-reported affective states, skin conductance levels) as well as on state paranoia, were tested. Subjective benefit and appraisals of the intervention were explored. There were no specific intervention effects on negative self-relating, negative affect and skin-conductance or on paranoia. However, compassion-focused imagery had significant effects on self-reassurance and happiness. Explorative analyses revealed that the majority of the participants appraised the intervention in a positive manner, indicating good acceptance. The intervention showed an effect on some of the postulated mechanisms but not on others, which might have been because of its brevity. Further investigation of interventions targeting affiliation for people with paranoid experiences appears worthwhile. Copyright

Bridging psychophysiological and phenomenological characteristics of psychosis — Preliminary evidence for the relevance of emotion regulation

In psychosis, the alleged increased subjective stress-sensitivity is reflected in abnormal physiological arousal such as higher heart rate, elevated skin conductance levels, decreased vagal activity, and unusual cortisol levels. Despite ongoing research, possible mechanisms that explain the interplay between the phenomenological (i.e., subjective stress and symptoms) and psychophysiological processes are not thoroughly understood. Building on the model of neurovisceral integration by Thayer and Lane (2000) that focuses on regulative mechanisms, we postulate that emotion regulation will be associated with vagal activity, and with both subjective and physiological stress. In the present analysis, we used data from a baseline relaxation period including a 5-minute assessment of heart rate variability (HRV), salivary cortisol, and momentary subjective stress ratings from a sample of 19 participants with psychosis (mean age=40.9, SD=11.1; 36.8% female). Emotion regulation modification skills were assessed for specific emotions (i.e., stress and arousal, anxiety, anger, sadness, shame) if these were present during the previous week. Vagal HRV was significantly and moderately associated with emotion regulation. Both stress parameters (i.e., cortisol, subjective stress) were significantly associated with emotion regulation, but not with HRV. We provide preliminary support for the notion that emotion regulatory processes represent a crucial link between phenomenological and psychophysiological phenomena in psychosis. A potential model that ascribes emotion regulation a central role in the restoration of homeostasis is discussed. Future studies are needed to verify its generalizability and predictive value.

Ein Mythos von Jekyll und Hyde

AIM People widely believe that schizophrenia goes along with a split personality. Little is known, however, about the consequences of this belief. In this study, we tested whether the split-personality-belief is associated with stigmatization of schizophrenia. METHODS A sample of 416 persons was recruited from the general population. In an online-survey, the split-personality-belief, the stereotypes dangerousness and unpredictability/incompetence and individual discrimination (i. e. desired social distance) of persons diagnosed with schizophrenia were assessed by self-report. RESULTS The split-personality-belief was associated with increased perceived dangerousness, unpredictability/incompetence and desired social distance. Both stereotypes mediated the relationship of split-personality-belief and desired social distance. CONCLUSION The split-personality-belief is associated with and may even contribute to stigmatiziation of persons with schizophrenia. Efforts to reduce stigmatization are likely to benefit from battling this misconception.

Blinde Flecken? Der Einfluss von Stigma auf die psychotherapeutische Versorgung von Menschen mit Schizophrenie

Schizophreniepatienten beklagen eine geringe Verfügbarkeit von Psychotherapie als häufige Form der Stigmatisierung. In diesem Artikel untersuchen wir, inwiefern Patienten mit Schizophrenie psychotherapeutisch unterversorgt sind und ob es eine Benachteiligung von Patienten mit Schizophrenie gegenüber anderen Patientengruppen gibt. Weiterhin prüfen wir, inwiefern eine Benachteiligung durch individuelle und strukturelle Stigmatisierung verursacht wird. Zunächst erfolgt eine systematische Übersicht über die mögliche Unterversorgung und Benachteiligung bei der stationären und ambulanten psychotherapeutischen Behandlung. Anschließend beleuchten wir strukturelle Ursachen sowie Hinweise auf individuelle Stigmatisierung durch Behandler und stellen Studien vor, die den Zusammenhang zwischen individueller Stigmatisierung durch Behandler und versorgungsrelevanten Entscheidungen untersuchen. Hierbei zeigt sich, dass ein Großteil der Patienten mit Schizophrenie keine Psychotherapie erhält. Während die Datenlage zur stationären Versorgung nicht ausreicht, um eine etwaige Benachteiligung gegenüber anderen Patienten zu beurteilen, deuten Versorgungsquoten in der ambulanten Behandlung auf eine solche Benachteiligung hin. Mögliche strukturelle Ursachen hierfür sind die Aufrechterhaltung von Fehlannahmen über Schizophrenie in der Ausbildung und durch Entscheidungsträger im Versorgungssystem sowie die Komm-Struktur des Versorgungssystems. Stigmatisierende Einstellungen von Behandlern, insbesondere ein prognostischer Pessimismus, stellen potenzielle individuumsbezogene Ursachen dar. Eine Stigmatisierung im Versorgungssystem erfolgt sowohl durch Versorgungsstrukturen als auch individuell durch Behandler. Mögliche Maßnahmen zur Verbesserung dieses Missstands werden diskutiert.

The Relevance of Emotion Regulation in Explaining Why Social Exclusion Triggers Paranoia in Individuals at Clinical High Risk of Psychosis

Background Vulnerability-stress models postulate that social stress triggers psychotic episodes in vulnerable individuals. However, experimental evidence for the proposed causal pathway is scarce and the translating mechanisms are insufficiently understood. The study assessed the impact of social exclusion on paranoid beliefs in a quasi-experimental design and investigated the role of emotion regulation (ER) as a vulnerability indicator and emotional responses as a putative translating mechanism. Methods Participants fulfilling criteria for clinical high risk of psychosis (CHR, n = 25), controls with anxiety disorders (AC, n = 40), and healthy controls (HC, n = 40) were assessed for dysfunctional (eg, rumination, catastrophizing, blaming) and functional ER-strategies (eg, reappraising, accepting, refocusing). They were then exposed to social exclusion during a virtual ball game (Cyberball) and assessed for changes in self-reported emotions and paranoid beliefs. Results The CHR sample showed a significantly stronger increase in paranoid beliefs from before to after the social exclusion than both control groups. This was accounted for by lower levels of functional and higher levels of dysfunctional ER (compared to HC) and by a stronger increase in self-reported negative emotion in the CHR group (compared to AC and HC). Conclusions The results confirm the role of negative emotion on the pathway from social stressors to psychotic symptoms and indicate that both the use of dysfunctional ER strategies and difficulties in employing functional strategies add to explaining why people at risk of psychosis respond to a social stressor with increased paranoia.

Anxious but Thoroughly Informed? No Jumping-to-Conclusions Bias in Social Anxiety Disorder

Social anxiety disorder (SAD) is maintained by biased information processing, which might involve hasty decision making. This study tested whether SAD is associated with jumping-to-conclusions in neutral and socially threatening situations. Sixty participants with SAD and 56 healthy controls completed a beads-task and a Social Beads-Task (SBT) with neutral, threat-relevant, and self-relevant situations. Dependent variables were draws to decision (DTD) and certainty about the decision. In the beads-task, participants with SAD showed more DTD than controls. In the SBT, all participants drew fewer beads in threat- and self-relevant situations than in neutral scenarios. Participants with SAD reported higher certainty regarding their decision in the beads-task and in the threat- and self-relevant scenarios of the SBT. Jumping-to-conclusions increases when decision making is framed in a threatening or social-evaluative context. SAD may be linked to more certainty about decisions, but findings on group differences require further investigation.

Psychotic Experiences and Related Distress: A Cross-national Comparison and Network Analysis Based on 7141 Participants From 13 Countries

Psychotic experiences (PEs) are common in the general population but do not necessarily reflect a risk status if they occur in relative isolation or are not distressing. Emerging evidence suggests that PEs might be experienced as more benign for individuals from collectivistic low- and middle-income countries (LAMIC) compared with individualistic high-income countries (HIC). The aim of this study was to determine whether: (1) self-reported PEs are less distressing in community samples from LAMIC than from HIC; (2) the network of PEs is significantly less connected in a sample from LAMIC than from HIC. Adults from 8 HIC (n = 4669) and 5 LAMIC (n = 2472) were compared. The lifetime frequency of PEs and related distress were assessed with the Community Assessment of Psychic Experiences. We analyzed the associations of PEs with distress and country type. The interconnection of PEs was visualized by a network analysis and tested for differences in global connection strengths. The average endorsement rates of PEs were significantly higher in LAMIC than in HIC (χ2 = 1772.87, P < .01, Φcramer = 0.50). There was a universal positive correlation between higher frequency of PEs and more distress, but the distress levels controlled for frequency were significantly higher in HIC (R2 = 0.11; b = 0.26; SE = 0.01; T = 17.68; P < .001). Moreover, the network of PEs was significantly less connected in LAMIC (S = 0.40, P < .05). The findings indicate that PEs are of less clinical relevance in LAMIC compared with HIC. The universal use of current high-risk criteria might thus not be adequate without consideration of associated distress and cultural values.

Measuring fluctuations across the Continuum of Auditory Hallucinations. Development and validation of a state inventory

In order to identify causes and triggers of hallucinations that can inform therapy, reliable, valid, and change-sensitive instruments to assess hallucinatory experiences in the subclinical and clinical range are needed. We developed and validated a novel scale, the Continuum of Auditory Hallucinations - State Assessment (CAHSA), to be used for repeated assessment of the subclinical factors vivid imagination, intrusive thoughts, and perceptual sensitivity as well as auditory hallucinations. After selecting items for the four factors in a first test sample (n=84), we tested factorial validity using CFA and criterion validity with self-reported psychosis-like experiences (n=534). Finally, within-subject variation of CAHSA scores over 14 days and time-lagged associations between its factors were explored (n=85). A 9-item CAHSA was selected that showed good factorial validity, criterion validity, and substantial, valid within-subject variation. Time-lagged regression showed that vivid imagination, perceptual sensitivity, and intrusive thought precede auditory hallucinations. In sum, the CAHSA validly measures fluctuation along the continuum of auditory hallucinations, is sensitive to change, and well suited for experimental studies, repeated measurement, and longitudinal research.