Relationship between developmental factors and daily stressors in the context of psychotic experiences: an experience sampling study

Abstract

BACKGROUND: This thesis examines whether developmental factors influence the way young people respond to daily stressors in the context of psychotic experiences. Although there is a clear theoretical argument for attachment to be related to mentalization and emotion regulation, empirical research is lacking that examines links between these concepts. It is therefore unclear if attachment styles and mentalization impact on how young people manage their emotions in daily life. Experience sampling methodology (ESM) is used to study psychological constructs in daily life where the flow of emotions and experiences is reported in context and in real-time. ESM is often employed through digital technology and can bring potential opportunities to both research and clinical practice by contributing to a greater understanding of individual mental health and lead to innovations in psychological interventions.

OBJECTIVES: This thesis will examine several key objectives; 1) whether attachment, mentalization and emotion regulation are related, and if mentalization mediates the relationship between attachment and emotion regulation, 2) whether attachment security and psychotic experiences influence stress sensitivity, 3) whether attachment security and mentalizing ability relate to aspects of an individuals’ social context, 4) whether first episode psychosis (FEP) participants report using maladaptive emotion regulation strategies in daily life. Given the prominence of ESM throughout this thesis, a further objective will be 5) to examine whether emotion regulation data collected through self-report and ESM are significantly related, to establish whether ESM taps into a different aspect of subjective experience when compared to self-report.

METHODOLOGY: 55 young people aged between 16-35 years consented to take part in the current study and were recruited in the community and through clinical services across Lothian. Participants completed several measures; the Adult Attachment Interview (AAI), the Comprehensive Assessment of At-Risk Mental States (CAARMS); the Difficulties in Emotion Regulation Scale (DERS) and the Adolescent Coping Scale (ACS). Participants also completed 6 days of experience sampling with questions regarding emotions, daily stressors and emotion regulation strategies.

RESULTS: Results demonstrated associations between attachment, emotion regulation and mentalization with mentalization mediating the relationship between attachment security and greater difficulties managing emotions and reduced problem focused coping. Attachment security was associated with positive emotion and reducing social stress sensitivity in this group of young people. Additionally, psychotic experiences were associated with increasing social stress sensitivity. Attachment security and mentalizing ability did not influence appraisals of social context directly, however there were interaction effects of mentalization. Mentalization buffered the negative relationship between reported enjoyment when alone and psychotic experiences, as well as buffering the positive relationship between psychotic experiences and preference to be alone. FEP participants reported using maladaptive emotion regulation strategies in daily life. Emotion regulation strategies measured through self-report and ESM were related through one self-report subscale only suggesting ESM measures a different aspect of subjective experience.

DISCUSSION: This thesis supports attachment theory as a theory of resilience as attachment security buffered the effect of social stress on emotion in daily life. Results also highlight the relationship between social stress sensitivity and psychotic experiences supporting an affective pathway to psychosis. Promoting adaptive emotion regulation strategies and mentalizing ability to target outcomes such as stress sensitivity in young people should be considered in clinical practice. ESM can provide vast opportunities for clinical services, especially as this thesis demonstrated experience sampling measures a different aspect of subjective experience compared to self-report.

Through increased use of ESM, clinicians and researchers can obtain a greater understanding of individual mental health which can produce more individualised interventions.