Alyssa Jongeneel1, Roos Pot-Kolder2, Jacqueline Counotte3, Mark van der Gaag4, Wim Veling5. 1. VU University and Amsterdam Public Health research institute, Department of Clinical Psychology, Amsterdam, the Netherlands; Parnassia Psychiatric Institute, The Hague, the Netherlands. Electronic address: a.jongeneel@parnassiagroep.nl. 2. VU University and Amsterdam Public Health research institute, Department of Clinical Psychology, Amsterdam, the Netherlands; Arkin Mental Health Care Institute, Amsterdam, the Netherlands. 3. Parnassia Psychiatric Institute, The Hague, the Netherlands. 4. VU University and Amsterdam Public Health research institute, Department of Clinical Psychology, Amsterdam, the Netherlands; Parnassia Psychiatric Institute, The Hague, the Netherlands. 5. University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands.
Abstract
BACKGROUND: Higher liability to psychosis is associated with low self-esteem and increased sensitivity to social stress. Recently, we reported a positive relation between liability to psychosis and affective and psychotic responses to social stress. This study investigated how self-esteem moderates paranoia, peak subjective distress and stress reactivity of people with different psychosis liability in response to social stressors in virtual reality. METHODS: Ninety-four individuals with lower (41 siblings and 53 controls) and 75 persons with higher psychosis liability (55 with recent onset psychotic disorder and 20 at ultra-high risk for psychosis) explored five times a virtual café with various social stressors (crowdedness, ethnic minority status, and hostility). They rated momentary paranoia (State Social Paranoia Scale) after each experiment and subjective distress on a visual analogue scale before and after the experiments. Positive and negative self-esteem were assessed with the Self-Esteem Rating Scale. RESULTS: Momentary paranoia, peak subjective distress, and reactivity to social stressors were associated with negative self-esteem, but not positive self-esteem. Effects of both positive and negative self-esteem on psychotic and affective stress responses, but not stress reactivity, became significantly stronger when individuals were exposed to more stressful environments. Effects of self-esteem on momentary paranoia and peak subjective distress did not differ between the high liability and low liability group. Persons with lower psychosis liability had a stronger effect of negative self-esteem on stress reactivity than persons with higher liability. CONCLUSIONS: Positive and negative self-esteem may play an important role in affective and psychotic responses to social stress.
BACKGROUND: Higher liability to psychosis is associated with low self-esteem and increased sensitivity to social stress. Recently, we reported a positive relation between liability to psychosis and affective and psychotic responses to social stress. This study investigated how self-esteem moderates paranoia, peak subjective distress and stress reactivity of people with different psychosis liability in response to social stressors in virtual reality. METHODS: Ninety-four individuals with lower (41 siblings and 53 controls) and 75 persons with higher psychosis liability (55 with recent onset psychotic disorder and 20 at ultra-high risk for psychosis) explored five times a virtual café with various social stressors (crowdedness, ethnic minority status, and hostility). They rated momentary paranoia (State Social Paranoia Scale) after each experiment and subjective distress on a visual analogue scale before and after the experiments. Positive and negative self-esteem were assessed with the Self-Esteem Rating Scale. RESULTS:Momentary paranoia, peak subjective distress, and reactivity to social stressors were associated with negative self-esteem, but not positive self-esteem. Effects of both positive and negative self-esteem on psychotic and affective stress responses, but not stress reactivity, became significantly stronger when individuals were exposed to more stressful environments. Effects of self-esteem on momentary paranoia and peak subjective distress did not differ between the high liability and low liability group. Persons with lower psychosis liability had a stronger effect of negative self-esteem on stress reactivity than persons with higher liability. CONCLUSIONS: Positive and negative self-esteem may play an important role in affective and psychotic responses to social stress.
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