The Many Roads on the Affective Pathway to Psychosis. A S-GIMME-Network Analysis of the Association Between Negative Emotions and Psychosis Symptom States in Everyday Life

Abstract Purpose Ecological momentary assessment (EMA) studies converge on the finding that negative affect and psychosis symptoms (e.g., paranoia, hallucinations) are closely linked, with negative affect potentially triggering psychosis symptoms. A deeper understanding of the between-person variability within this affective pathway to psychosis could both benefit case conceptualization in clinical practice and potentially further refine etiological models of psychosis. In this study we re-analysed four EMA-studies and explored whether the associations between negative emotions and concurrent/subsequent paranoia/hallucinations are common across people or vary between individuals. Methods EMA-data of negative emotions and psychosis symptoms from two population and two patient samples (assessment intervals: 20–150 min) were subjected to Group Iterative Multiple Model Estimation network analysis to explore which associations between negative emotions and concurrent/subsequent hallucinations and paranoia are found universally (i.e., in more than 50% of the sample) vs. only in individuals. Results Most associations between hallucinations/paranoia and emotions varied between individuals. Two networks yielded population-wide cross-sectional connections between anxiety and paranoia and shame and paranoia, respectively. Nevertheless, the vast majority of individual networks included one or more associations between negative emotions and symptoms. Conclusion These results have to be interpreted cautiously due to the low number of assessments per individual in most samples, but they tentatively suggest that the affective path to psychosis shows considerable inter-individual variability. Within this diversity of individually different associations, different connections between negative emotions and concurrent/subsequent psychosis symptoms are consistently found, highlighting the potential for combining the individual and global perspective in future research.