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Impact of stress on paranoia: an experimental investigation of moderators and mediators

Published online by Cambridge University Press:  22 October 2008

T. M. Lincoln ,
N. Peter ,
M. Schäfer  and
S. Moritz
T. M. Lincoln*
Affiliation:
Philipps-Universität Marburg, Marburg, Germany
N. Peter
Affiliation:
Philipps-Universität Marburg, Marburg, Germany
M. Schäfer
Affiliation:
Philipps-Universität Marburg, Marburg, Germany
S. Moritz
Affiliation:
Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
*
*Address for correspondence: Dr T. M. Lincoln, Section for Clinical Psychology and Psychotherapy, Faculty of Psychology, Philipps-Universität Marburg, Gutenbergstr. 18, 35032 Marburg, Germany. (Email: lincoln@staff.uni-marburg.de)
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Abstract

Background

Vulnerability–stress models ascribe stress a pivotal role in the development of psychosis. However, moderating and mediating mechanisms translating stress into psychosis and the specificity of the association are not clearly established. It is hypothesized that stress will trigger paranoid ideation in vulnerable individuals through an increase in negative emotion.

Method

Using a repeated-measures design, 64 healthy participants with varying levels of vulnerability [psychosis symptoms assessed by the Community Assessment of Psychic Experiences (CAPE)] were assigned to a stress and a non-stress condition in random order. Stress was induced by exposing participants to building-site noise (75 dB) applied concurrently with difficult knowledge questions. Symptoms of paranoia, depression and obsessive compulsive disorder (OCD) were assessed by state-adapted versions of clinical scales.

Results

In the stress condition there was an increase in paranoia, depression and negative emotion. Multilevel linear modeling (MLM) revealed the increase in paranoia under stress to be moderated by the level of vulnerability and mediated by anxiety. Although participants generally showed an increase in anxiety under stress, anxiety was more strongly related to paranoia in participants with higher baseline symptomatology.

Conclusions

The results support and specify the role of emotional reactions to stressors on the pathway from vulnerability to psychosis and highlight the relevance of anxiety.

Keywords

Anxietyemotionparanoiastressvulnerability
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 7 , July 2009 , pp. 1129 - 1139
Copyright
Copyright © 2008 Cambridge University Press

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References

Abramson, LY, Metalsky, GI, Alloy, LB (1989). Hopelessness depression: a theory-based subtype of depression. Psychological Review 96, 358–372.CrossRefGoogle Scholar
Andreasen, NC, Flaum, M (1991). Schizophrenia: the characteristic symptoms. Schizophrenia Bulletin 17, 27–49.CrossRefGoogle ScholarPubMed
Behrendt, B (2001). My Personal Warning Signals. A Relapse Prevention Therapy Programme for Schizophrenia and Schizoaffective Disorders [in German]. dgvt Verlag: Tübingen.Google Scholar
Bell, RQ (1992). Multiple-risk cohorts and segmenting risk as solutions to the problem of false positives in risk for the major psychoses. Psychiatry Research 55, 370–381.Google Scholar
Birley, JL, Brown, GW (1970). Crises and life changes preceding the onset or relapse of acute schizophrenia: clinical aspects. British Journal of Psychiatry 116, 327–333.CrossRefGoogle ScholarPubMed
Brewer, WJ, Wood, SJ, Phillips, LJ, Francey, SM, Pantelis, C, Yung, AR, Cornblatt, R, McGorry, PD (2006). Generalized and specific cognitive performance in clinical high-risk cohorts: a review highlighting potential vulnerability markers for psychosis. Schizophrenia Bulletin 32, 538–555.CrossRefGoogle ScholarPubMed
Brown, GW, Birley, JLT (1968). Crises and life changes and the onset of schizophrenia. Journal of Health and Social Behavior 9, 203–214.CrossRefGoogle ScholarPubMed
Butzlaff, RL, Hooley, JM (1998). Expressed emotion and psychiatric relapse. A meta-analysis. Archives of General Psychiatry 55, 547–552.CrossRefGoogle ScholarPubMed
Cantor-Graae, E, Selton, JP (2005). Schizophrenia and migration: a meta-analysis and review. American Journal of Psychiatry 162, 12–24.CrossRefGoogle ScholarPubMed
Cohen, AS, Docherty, NM (2004). Affective reactivity of speech and emotional experience in patients with schizophrenia. Schizophrenia Research 69, 7–14.CrossRefGoogle ScholarPubMed
Cutting, LP, Aakre, JM, Docherty, NM (2006). Schizophrenic patients' perceptions of stress, expressed emotion, and sensitivity to criticism. Schizophrenia Bulletin 32, 743–750.CrossRefGoogle ScholarPubMed
Derogatis, LR (1983). SCL-90: Administration, Scoring, and Procedures Manual for the Revised Version. Clinical Psychometric Research: Baltimore.Google Scholar
Dinzeo, TJ, Cohen, AS, Nienow, TM, Docherty, NM (2004). Stress and arousability in schizophrenia. Schizophrenia Research 71, 127–135.CrossRefGoogle ScholarPubMed
Docherty, NM, Hall, M, Gordinier, SW (1998). Affective reactivity of speech in schizophrenia patients and their nonschizophrenic relatives. Journal of Abnormal Psychology 107, 461–467.CrossRefGoogle ScholarPubMed
Docherty, NM, St-Hilaire, A, Aakre, JM, Seghers, JP (2008). Life events and high-trait reactivity together predict psychotic symptom increases in schizophrenia. Schizophrenia Bulletin. Published online: 31 January 2008. doi:10.1093/schbul/sbn002.Google ScholarPubMed
Foa, EB, Huppert, JD, Leiberg, S, Langner, R, Kichnic, R, Hajcak, G, Salkovskis, PM (2002). The Obsessive-Compulsive Inventory: development and validation of a short version. Psychological Assessment 14, 485–496.CrossRefGoogle ScholarPubMed
Freeman, D (2006). Delusions in the nonclinical population. Current Psychiatry Reports 8, 191–204.CrossRefGoogle ScholarPubMed
Freeman, D, Garety, P, Kuipers, E, Fowler, D, Bebbington, P (2002). A cognitive model of persecutory delusions. British Journal of Clinical Psychology 41, 331–347.CrossRefGoogle ScholarPubMed
Freeman, D, Garety, PA, Bebbington, PE, Smith, B, Rollinson, R, Fowler, D, Kuipers, E, Ray, K, Dunn, G (2005). Psychological investigation of the structure of paranoia in a non-clinical population. British Journal of Psychiatry 186, 427–435.CrossRefGoogle Scholar
Freeman, D, Garety, PA, Kuipers, E (2001). Persecutory delusions: developing the understanding of belief maintenance and emotional distress. Psychological Medicine 31, 1293–1306.CrossRefGoogle ScholarPubMed
Freeman, D, Pugh, K, Antley, A, Slater, M, Bebbington, P, Gittins, M, Dunn, G, Kuipers, E, Garety, PA (2008). Virtual reality study of paranoid thinking in the general population. British Journal of Psychiatry 192, 258–263.CrossRefGoogle ScholarPubMed
Freeman, D, Pugh, K, Green, C, Valmaggia, LR, Dunn, G, Garety, PA (2007). A measure of state persecutory ideation for experimental studies. Journal of Nervous and Mental Disease 195, 781–784.CrossRefGoogle ScholarPubMed
Garety, PA, Freeman, D, Jolley, S, Dunn, G, Bebbington, PE, Fowler, DG, Kuipers, E, Dudley, R (2005). Reasoning, emotions, and delusional conviction in psychosis. Journal of Abnormal Psychology 114, 373–384.CrossRefGoogle ScholarPubMed
Garety, PA, Kuipers, L, Fowler, D, Freeman, D, Bebbington, P (2001). A cognitive model of the positive symptoms of psychosis. Psychological Medicine 31, 189–195.CrossRefGoogle ScholarPubMed
Gönner, S, Leonhart, R, Ecker, W (2007). The German version of the Obsessive-Compulsive Inventory-Revised: a brief self-report measure for the multidimensional assessment of obsessive-compulsive symptoms [in German]. Psychotherapie, Psychosomatik, Medizinische Psychologie 57, 395–404.CrossRefGoogle ScholarPubMed
Hanssen, M, Peeters, F, Krabbendam, L, Radstake, S, Verdoux, H, van Os, J (2003). How psychotic are individuals with non-psychotic disorders? Social Psychiatry and Psychiatric Epidemiology 38, 149–154.CrossRefGoogle ScholarPubMed
Hautzinger, M, Brähler, M (1993). General Depression Scale (ADS) [in German]. Hogrefe: Göttingen.Google Scholar
Horan, WP, Ventura, J, Nuechterlein, KH, Subotnik, KL, Hwang, SS, Mintz, J (2005). Stressful life events in recent-onset schizophrenia: reduced frequencies and altered subjective appraisals. Schizophrenia Research 75, 363–374.CrossRefGoogle ScholarPubMed
Hox, J (2002). Multilevel Analysis. Techniques and Applications. Lawrence Erlbaum Associates: Mahwah, NJ.CrossRefGoogle Scholar
Janssen, I, Hanssen, M, Bak, M, Bilj, RV, De Graaf, R, Vollebergh, W, McKenzie, K, Van Os, J (2003). Discrimination and delusional ideation. British Journal of Psychiatry 182, 71–76.CrossRefGoogle ScholarPubMed
Kessler, RC (1997). The effects of stressful life events on depression. Annual Review of Psychology 48, 191–214.CrossRefGoogle ScholarPubMed
Konings, M, Bak, M, Hanssen, M, van Os, J, Krabbendam, L (2006). Validity and reliability of the CAPE: a self-report instrument for the measurement of psychotic experiences in the general population. Acta Psychiatrica Scandinavica 114, 55–61.CrossRefGoogle Scholar
Krull, JL, MacKinnon, DP (2001). Multilevel modeling of individual and group level mediated effects. Multivariate Behavioral Research 36, 249–277.CrossRefGoogle ScholarPubMed
Lincoln, TM, Keller, E (2008). Problems in assessing delusions and hallucinations in student populations. Psychology and Psychotherapy: Theory, Research and Practice 81, 231–235.CrossRefGoogle Scholar
Lincoln, TM, Wilhelm, K, Nestoriuc, Y (2007). Effectiveness of psychoeducation for relapse, symptoms, knowledge, adherence and functioning in schizophrenia: a meta-analysis. Schizophrenia Research 96, 232–245.CrossRefGoogle ScholarPubMed
Mason, O, Startup, M, Halpin, S, Schall, U, Conrad, A, Carr, V (2004). Risk factors for transition to first episode psychosis among individuals with ‘at-risk mental states’. Schizophrenia Research 71, 227–237.CrossRefGoogle ScholarPubMed
Miller, P, Lawrie, MS, Hodges, A, Clafferty, R, Cosway, R, Johnstone, EC (2001). Genetic liability, illicit drug use, life stress and psychotic symptoms. Preliminary findings from the Edinburgh study of people at high risk for schizophrenia. Social Psychiatry and Psychiatric Epidemiology 36, 338–342.CrossRefGoogle ScholarPubMed
Møller, P, Husby, R (2000). The initial prodrome in schizophrenia: searching for naturalistic core dimensions of experience and behavior. Schizophrenia Bulletin 26, 217–232.CrossRefGoogle ScholarPubMed
Moritz, S, Laroi, F (2008). Differences and similarities in the sensory and cognitive signatures of voice-hearing, intrusions and thoughts: voice-hearing is more than a disorder of input. Schizophrenia Research 102, 96–107.CrossRefGoogle Scholar
Muller, D, Judd, CM, Yzerbyt, VY (2005). When moderation is mediated and mediation is moderated. Journal of Personality and Social Psychology 89, 852–863.CrossRefGoogle ScholarPubMed
Myin-Germeys, I, Delespaul, P, Van Os, J (2005). Behavioural sensitization to daily life stress in psychosis. Psychological Medicine 35, 1–9.CrossRefGoogle ScholarPubMed
Myin-Germeys, I, Peeters, F, Havermans, R, Nicolson, NA, DeVries, MW, Delespaul, P, van Os, J (2003). Emotional reactivity to daily life stress in psychosis and affective disorder. An experience sampling study. Acta Psychiatrica Scandinavica 107, 124–131.CrossRefGoogle ScholarPubMed
Myin-Germeys, I, van Os, J (2007). Stress-reactivity in psychosis: evidence for an affective pathway to psychosis. Clinical Psychology Review 27, 409–424.CrossRefGoogle ScholarPubMed
Myin-Germeys, I, Van Os, J, Schwartz, JE, Stone, AA, Delespaul, P (2001). Emotional reactivity to daily life stress in psychosis. Archives of General Psychiatry 58, 1137–1144.CrossRefGoogle ScholarPubMed
Norman, RMG, Malla, AK (1991). Subjective stress in schizophrenic patients. Social Psychiatry and Psychiatric Epidemiology 26, 212–216.CrossRefGoogle ScholarPubMed
Norman, RMG, Malla, AK (1993 a). Stressful life events and schizophrenia. I: A review of the research. British Journal of Psychiatry 162, 161–166.CrossRefGoogle Scholar
Norman, RMG, Malla, AK (1993 b). Stressful life events and schizophrenia. II: Conceptual and methodological issues. British Journal of Psychiatry 162, 166–174.CrossRefGoogle ScholarPubMed
Norman, RMG, Malla, AK, McLean, TS, McIntosh, EM, Neufeld, RWJ, Voruganti, LP (2002). An evaluation of a stress management program for individuals with schizophrenia. Schizophrenia Research 58, 293–303.CrossRefGoogle ScholarPubMed
Nuechterlein, KH, Dawson, ME (1984). A heuristic vulnerability/stress model of schizophrenic episodes. Schizophrenia Bulletin 10, 300–312.CrossRefGoogle ScholarPubMed
Nuechterlein, KH, Dawson, ME, Ventura, J, Gitlin, M, Subotnik, KL, Snyder, KS, Mintz, J, Bartzokis, G (1994). The vulnerability stress model of schizophrenic relapses: a longitudinal study. Acta Psychiatrica Scandinavica 89, 58–65.CrossRefGoogle Scholar
Philipps, LJ, Francey, SM, Edwards, J, McMurray, N (2007). Stress and psychosis: towards the development of new models of investigation. Clinical Psychology Review 27, 307–317.CrossRefGoogle Scholar
Salokangas, RKR, Luutonen, S, Niemines, M, Huttunen, J, Karlsson, H (2007). Vulnerability to psychosis increases the risk of depression. Nordic Journal of Psychiatry 61, 393–402.CrossRefGoogle ScholarPubMed
Sartorius, N, Jablensky, A, Korten, A, Ernberg, G, Anker, M, Cooper, JE, Day, R (1986). Early manifestations and first-contact incidence of schizophrenia in different cultures. Psychological Medicine 16, 909–928.CrossRefGoogle ScholarPubMed
Simonds, LM, Thorpe, SJ, Elliott, SA (2000). The Obsessive Compulsive Inventory: psychometric properties in a nonclinical student sample. Behavourial and Cognitive Psychotherapy 28, 153–159.CrossRefGoogle Scholar
Soliman, A, O'Driscoll, GA, Pruessner, J, Halohan, A-LV, Boileau, I, Gagnon, D, Dagher, A (2008). Stress-induced dopamine release in humans at risk of psychosis: a [11C]raclopride PET study. Neuropsychopharmacology 33, 2033–2041.CrossRefGoogle ScholarPubMed
Stefanis, NC, Hanssen, M, Smirnis, NK, Avramopoulos, DA, Evdokimidis, I, Stefanis, CN (2002). Evidence that three dimensions of psychosis have a distribution in the general population. Psychological Medicine 32, 347–358.CrossRefGoogle ScholarPubMed
Stemmler, G, Heldmann, M, Pauls, C, Scherer, T (2001). Constraints for emotion specifity in fear and anger: the context counts. Psychophysiology 38, 275–291.CrossRefGoogle ScholarPubMed
Stroud, CB, Davila, J, Moyer, A (2008). The relationship between stress and depression in first onsets versus recurrences: a meta-analytic review. Journal of Abnormal Psychology 117, 206–213.CrossRefGoogle ScholarPubMed
Tabachnick, BG, Fidell, LS (2007). Using Multivariate Statistics, 5th edn. Pearson and Allyn & Bacon: Boston.Google Scholar
Thompson, KN, Phillips, LJ, Komesaroff, P, Yuen, HP, Wood, SJ, Pantelis, C, Velakoulis, D, Yung, AR, McGorry, PD (2007). Stress and HPA-axis functioning in young people at ultra high risk for psychosis. Journal of Psychiatric Research 41, 561–569.CrossRefGoogle ScholarPubMed
van Os, J, Hanssen, M, Bak, M, Bijl, RV, Vollebergh, W (2003). Do urbanicity and familial liability coparticipate in causing psychosis? American Journal of Psychiatry 160, 477–482.CrossRefGoogle ScholarPubMed
Van Os, J, Jones, P, Sham, P, Bebbington, P, Murray, RM (1998). Risk factors for onset and persistence of psychosis. Social Psychiatry and Psychiatric Epidemiology 33, 596–605.CrossRefGoogle ScholarPubMed
Veling, W, Susser, E, Van Os, J, Mackenbach, JP, Selten, JP, Hoek, HW (2007). Ethnic density of neighborhoods and incidence of psychotic disorders among immigrants. American Journal of Psychiatry 165, 66–73.CrossRefGoogle ScholarPubMed
Walker, EF, Diforio, D (1997). Schizophrenia: a neural diathesis-stress model. Psychological Review 104, 667–685.CrossRefGoogle ScholarPubMed
Weiser, M, Van Os, J, Reichenberg, A, Rabinowitz, J, Nahon, D, Kravitz, E, Lubin, G, Shmushkevitz, M, Knobler, HY, Noy, S, Davidson, M (2007). Social and cognitive functioning, urbanicity and risk for schizophrenia. British Journal of Psychiatry 191, 320–324.CrossRefGoogle ScholarPubMed
Wiedemann, G, Klingberg, S, Pitschel-Walz, G, Arbeitsgruppe-Psychoedukation (2003). Psychoeducative interventions in the treatment of patients with schizophrenia [in German]. Nervenarzt 74, 789–808.CrossRefGoogle Scholar
Yung, AR, Phillips, LJ, Yuen, HP, Francey, SM, McFarlane, CA, Hallgren, M, McGorry, PD (2003). Psychosis prediction: 12-month follow up of a high-risk (prodromal) group. Schizophrenia Research 60, 21–32.CrossRefGoogle ScholarPubMed
Zubin, J, Spring, B (1977). Vulnerability – a new view of schizophrenia. Journal of Abnormal Psychology 86, 103–126.CrossRefGoogle ScholarPubMed