Modeling the Interplay Between Psychological Processes and Adverse, Stressful Contexts and Experiences in Pathways to Psychosis: An Experience Sampling Study

Klippel, A., Myin-Germeys, I., Chavez-Baldini, U., Preacher, K. J., Kempton, M., Valmaggia, L., Calem, M., So, S., Beards, S., Hubbard, K., Gayer-Anderson, C., Onyejiaka, A., Wichers, M., McGuire, P., Murray, R., Garety, P., van Os, J., Wykes, T., Morgan, C. & Reininghaus, U., 1-Mar-2017, In : Schizophrenia Bulletin. 43, 2, p. 302-315 14 p.

Research output: Contribution to journalArticleAcademicpeer-review

Copy link to clipboard


  • Modeling the Interplay Between Psychological Processes and Adverse, Stressful Contexts

    Final publisher's version, 603 KB, PDF document


  • Annelie Klippel
  • Inez Myin-Germeys
  • UnYoung Chavez-Baldini
  • Kristopher J. Preacher
  • Matthew Kempton
  • Lucia Valmaggia
  • Maria Calem
  • Suzanne So
  • Stephanie Beards
  • Kathryn Hubbard
  • Charlotte Gayer-Anderson
  • Adanna Onyejiaka
  • Marieke Wichers
  • Philip McGuire
  • Robin Murray
  • Philippa Garety
  • Jim van Os
  • Til Wykes
  • Craig Morgan
  • Ulrich Reininghaus

Several integrated models of psychosis have implicated adverse, stressful contexts and experiences, and affective and cognitive processes in the onset of psychosis. In these models, the effects of stress are posited to contribute to the development of psychotic experiences via pathways through affective disturbance, cognitive biases, and anomalous experiences. However, attempts to systematically test comprehensive models of these pathways remain sparse. Using the Experience Sampling Method in 51 individuals with first-episode psychosis (FEP), 46 individuals with an atrisk mental state (ARMS) for psychosis, and 53 controls, we investigated how stress, enhanced threat anticipation, and experiences of aberrant salience combine to increase the intensity of psychotic experiences. We fitted multilevel moderated mediation models to investigate indirect effects across these groups. We found that the effects of stress on psychotic experiences were mediated via pathways through affective disturbance in all 3 groups. The effect of stress on psychotic experiences was mediated by threat anticipation in FEP individuals and controls but not in ARMS individuals. There was only weak evidence of mediation via aberrant salience. However, aberrant salience retained a substantial direct effect on psychotic experiences, independently of stress, in all 3 groups. Our findings provide novel insights on the role of affective disturbance and threat anticipation in pathways through which stress impacts on the formation of psychotic experiences across different stages of early psychosis in daily life.

Original languageEnglish
Pages (from-to)302-315
Number of pages14
JournalSchizophrenia Bulletin
Issue number2
Publication statusPublished - 1-Mar-2017


  • stress sensitivity, aberrant salience, threat anticipation, experience sampling method, first-episode psychosis, at-risk mental state, DAILY-LIFE STRESS, ULTRA-HIGH RISK, PERSECUTORY DELUSIONS, MODERATED MEDIATION, CHILDHOOD TRAUMA, SCHIZOPHRENIA, REACTIVITY, DISORDERS, INDIVIDUALS, DEPRESSION

ID: 41098947