Predicting Sexual Desire in Daily Life from an Attachment Perspective: An Experience Sampling study.

In the present study we investigated the temporal associations between emotional intimacy, daily hassles, and sexual desire of individuals in long-term relationships, and examined the direct and moderating effects of attachment orientation. We investigated these variables by reanalyzing an existing data set. Experience sampling methodology was used to collect data 10 times per day, across seven days. Attachment orientation was assessed with the Experiences in Close Relationships questionnaire. Age, gender, and relationship duration were added as predictors. Data of 134 participants (Nfemale = 87) were analyzed. Only one of the partners of a couple participated. Men overall reported higher sexual desire than women. Longer relationship duration was associated with lower sexual desire, but age was not associated with sexual desire. Increased level of intimacy predicted sexual desire across measurements with an average time interval of 90 min, but this effect was no longer significant when assessment points were 180 min apart. Daily hassles did not predict sexual desire at subsequent assessments. Avoidant and anxious attachment were not associated with sexual desire level. No interaction effects of gender, stress, intimacy and attachment orientation on sexual desire were found. Speculative explanations are offered for the absence of stress effects.

Associations between affect and alcohol consumption in adults: an ecological momentary assessment study.

Background: Consuming alcohol for coping with negative affect (NA) or enhancing positive affect (PA) may lead to risky drinking patterns. Previous research has yielded mixed findings regarding these affective drinking associations.Objectives: To examine support for the self-medication and expectancy models of alcohol use in an adult community sample, by examining reciprocal associations between alcohol consumption and NA and PA within and between persons.Methods: During seven consecutive days, 162 adults from the community (109 female) reported their affective experiences and alcohol consumption, following a signal contingent ecological momentary assessment protocol on their smartphones.Results: Within-person daily NA preceding the first drinking event was associated with increased likelihood of same-day alcohol consumption. Within-person momentary NA was associated with a decrease in the amount of next-moment alcohol consumption. Within-person momentary PA was positively associated with likelihood of next-moment alcohol consumption. Between persons, levels of daily and momentary NA and PA were not associated with any index of alcohol consumption. The intercepts and slopes of NA were not significantly different before and after alcohol consumption. The intercept of PA was higher after alcohol consumption, whereas the slope of PA decreased after alcohol consumption.Conclusion: In the current sample affective drinking was a within-person process (i.e. persons were sensitive to their varying levels of affect). Some support was found for the self-medication and expectancy models. People may drink for coping with NA, but may also be at risk for developing affective drinking patterns in response to PA.

Cultural differences in positive psychotic experiences assessed with the Community Assessment of Psychic Experiences-42 (CAPE-42): a comparison of student populations in the Netherlands, Nigeria and Norway.

BACKGROUND: Previous studies have suggested that culture impacts the experience of psychosis. The current study set out to extend these findings by examining cultural variation in subclinical positive psychotic experiences in students from The Netherlands, Nigeria, and Norway. Positive psychotic experiences were hypothesized to (i) be more frequently endorsed by, and (ii) cause less distress in Nigerian vs. Dutch and Norwegian students. METHODS: Psychology students, aged 18 to 30 years, from universities in the Netherlands (n = 245), Nigeria (n = 478), and Norway (n = 162) were assessed cross-sectionally with regard to the frequency of subclinical positive psychotic experiences and related distress, using the Community Assessment of Psychic Experiences (CAPE-42). Multi-group confirmatory factor analysis and multivariate analysis of covariance were performed to assess measurement invariance of the positive symptom dimension (CAPE-Pos) and compare mean frequency and associated distress of positive psychotic experiences across study samples. RESULTS: Only CAPE-Pos items pertaining to the dimensions 'strange experiences' and 'paranoia' met assumptions for (partial) measurement invariance. Frequencies of these experiences were higher in the Nigerian sample, compared to both the Dutch and Norwegian samples, which were similar. In addition, levels of experience-related distress were similar or higher in the Nigerian sample compared to respectively the Dutch and Norwegian samples. CONCLUSION: Although positive psychotic experiences may be more commonly endorsed in non-Western societies, our findings do not support the notion that they represent a more benign, and hence less distressing aspect of human experience. Rather, the experience of psychotic phenomena may be just as, if not more, distressing in African than in European culture. However, observed differences in CAPE-Pos frequency and distress between samples from different cultural settings may partly reflect differences in the measure rather than in the latent trait. Future studies may therefore consider further cross-cultural adaptation of CAPE-42, in addition to explicitly examining cultural acceptance of psychotic phenomena, and environmental and other known risk factors for psychosis, when comparing and interpreting subclinical psychotic phenomena across cultural groups.

Habit strength and between-meal snacking in daily life: the moderating role of level of education.

OBJECTIVE: Recent research emphasizes the importance of habit in explaining patterns of energy intake and choices of consumption. However, the nature of the association between habit strength and snacking has not been explored for all types of between-meal snacks. DESIGN: Multilevel linear techniques were used to: (i) examine the association between habit strength and moment-to-moment energy intake (kilocalories) from snacks in daily life; and (ii) determine whether gender, age, level of education and BMI moderate the association between habit strength and moment-to-moment energy intake from snacks. A smartphone application based on the experience sampling method was used to map momentary between-meal snack intake in the context of daily life. Demographics and habit strength were assessed with an online composite questionnaire. SETTING: This research was performed in the Netherlands in the natural environment of participants' daily life. SUBJECTS: Adults (n 269) aged 20-50 years. RESULTS: Habit strength was significantly associated with moment-to-moment energy intake from between-meal snacks in daily life: the higher the strength of habit to snack between meals, the higher the amount of momentary energy intake from snacks. The association between habit strength and moment-to-moment energy intake from snacks was moderated by education level. Additional analyses showed that habit strength was significantly associated with moment-to-moment energy intake from between-meal snacks in the low to middle level of education group. CONCLUSIONS: It is recommended to address habitual between-meal snacking in future interventions targeting low- to middle-educated individuals.

The associations of intimacy and sexuality in daily life: Temporal dynamics and gender effects within romantic relationships.

The experience of emotional intimacy is assumed to play a particularly large role in maintaining sexual desire and partnered sexual activity in romantic relationships of longer duration. It is unclear whether the effect of intimacy on sexual contact between partners is direct or indirect, via its impact on sexual desire. Baumeister and Bratslavsky suggested that a certain increment in emotional intimacy causes a greater increment in sexual desire in men than in women. In the present study, we aimed to test the mediating role of sexual desire between perceived intimacy and sexual partner interaction and the gender effect as hypothesized by Baumeister and Bratslavsky. Experience sampling methodology in the participant's natural environment was used. At 10 quasi-random moments per day, during 7 consecutive days, 134 participants reported their feelings of emotional intimacy, sexual desire, and sexual activity. The direct effect of intimacy on sexual partner interaction was not significant, but an indirect effect via sexual desire was observed. The strength of the association between intimacy and sexual desire diminished over time, from the strongest effect when intimacy, sexual desire, and sexual activity were measured simultaneously to a very small, but significant effect at an average time lag of 3 hr. At still larger time gaps, no effects were found. Men reported a higher average level of sexual desire than women, but the strength of the link between (increases in) intimacy and sexual desire was not different between the genders. The present findings suggest that in both male and female partners in romantic, long-term relationships, higher levels of intimacy are associated with higher sexual desire, which is, in turn, associated with higher odds for partnered sexual activity to occur. The temporal association of increasing intimacy and subsequent sexual desire appears not to be different in women and men.

Assessing Energy Intake in Daily Life: Signal-Contingent Smartphone Application Versus Event-Contingent Paper and Pencil Estimated Diet Diary.

OBJECTIVES: Investigating between-meal snack intake and its associated determinants such as emotions and stress presents challenges because both vary from moment to moment throughout the day. A smartphone application (app), was developed to map momentary between-meal snack intake and its associated determinants in the context of daily life. The aim of this study was to compare energy intake reported with the signal-contingent app and reported with an event-contingent paper and pencil diet diary. METHODS: In a counterbalanced, cross-sectional design, adults (N = 46) from the general population reported between-meal snack intake during four consecutive days with the app and four consecutive days with a paper and pencil diet diary. A 10-day interval was applied between the two reporting periods. Multilevel regression analyses were conducted to compare both instruments on reported momentary and daily energy intake from snacks. RESULTS: Results showed no significant difference (B = 11.84, p = .14) in momentary energy intake from snacks between the two instruments. However, a significant difference (B = -105.89, p < .01) was found on energy intake from total daily snack consumption. CONCLUSIONS: As at momentary level both instruments were comparable in assessing energy intake, research purposes will largely determine the sampling procedure of choice. When momentary associations across time are the interest of study, a signal-contingent sampling procedure may be a suitable method. Since the compared instruments differed on two main features (i.e. the sampling procedure and the device used) it is difficult to disentangle which instrument was the most accurate in assessing daily energy intake.

Factors Associated With Intention and Use of e-Mental Health by Mental Health Counselors in General Practices: Web-Based Survey.

BACKGROUND: Mental health care counselors have a high intention to use e-mental health (EMH), whereas actual use is limited. Facilitating future use requires insight into underlying factors as well as eligibility criteria that mental health care counselors use in their decision to apply EMH. OBJECTIVE: The aim of this study was to unfold the intention and underlying reasons for mental health counselors to use EMH and to unveil the criteria they use to estimate patient eligibility for EMH. The theoretical framework was based on the reasoned action approach model, the Unified Theory of Acceptance and Use of Technology, and the Measurement Instrument for Determinants of Innovation model. METHODS: To empirically validate our theoretical model, a web-based survey was conducted among mental health care counselors (n=132). To unveil the eligibility criteria, participants were asked to rank their reasons for considering EMH suitable or unsuitable for a patient. RESULTS: The mean intention to use EMH was positive (mean 4.04, SD 0.64). The mean use of EMH before the COVID-19 pandemic was 38% (mean 0.38, SD 0.22), and it was 49% (mean 0.49, SD 0.25) during the pandemic. In total, 57% of the patient population was considered eligible for EMH. Usefulness and benefits (ß=.440; P<.001), Task perception (ß=.306; P=.001), and Accessibility (ß=.140; P=.02) explained the intention to use EMH (F3,131=54.151; P<.001; R2=0.559). In turn, intention explained patient eligibility (F1,130=34.716; P<.001; R2=0.211), whereas intention and patient eligibility explained EMH use (F2,129=41.047; P<.001; R2=0.389). Patient eligibility partially mediated the relationship between intention to use EMH and EMH use, with a larger direct effect (c'=0.116; P<.001) than indirect effect (c=0.065, 95% CI 0.035-0.099; P<.001). Mental health counselors assessed patients' eligibility for EMH mainly through the availability of computers and the internet and patient motivation. CONCLUSIONS: To stimulate the use of EMH, intention and patient eligibility need to be influenced. Intention, in turn, can be enhanced by addressing the perceived usefulness and benefits of EMH, perceived accessibility, and task perception. Access to a computer and patients' motivation to use EMH are important in facilitating patient eligibility. To cause an impact with EMH in general practice, mental health counselors need to be convinced of the benefits of EMH and transfer this enthusiasm to the patient. It is recommended to involve mental health counselors in the development of EMH to increase the (perceived) added value and use.

Emotions, self-esteem, and paranoid episodes: an experience sampling study.

OBJECTIVES. The evidence to date for a causal role of emotions in the generation of paranoid symptoms is scarce, mainly because of a lack of studies investigating the longitudinal association between emotional processes and paranoia. The primary aim of this study was to investigate whether momentary emotional experiences (anxiety, depression, anger/irritability) and self-esteem predicted the onset and duration of a paranoid episode. We also studied whether levels of emotional experiences and self-esteem were respectively higher and lower during a paranoid episode. DESIGN. A 1-week, prospective momentary assessment study. METHODS. Data were collected using the experience sampling method, a structured self-assessment diary technique. The sample consisted of 158 individuals who ranged across the paranoia continuum. Participants with a psychotic disorder were recruited from in-patient and out-patient mental health services. Participants without psychotic disorder were sampled from the general population. RESULTS. Specific aspects of emotional experience were implicated in the onset and persistence of paranoid episodes. Both an increase in anxiety and a decrease in self-esteem predicted the onset of paranoid episodes. Cross-sectionally, paranoid episodes were associated with high levels of all negative emotions and low level of self-esteem. Initial intensity of paranoia and depression was associated with longer, and anger/irritability with shorter duration of paranoid episodes. CONCLUSIONS. Paranoid delusionality is driven by negative emotions and reductions in self-esteem, rather than serving an immediate defensive function against these emotions and low self-esteem. Clinicians need to be aware of the central role of emotion-related processes and especially self-esteem in paranoid thinking.

Temporal associations between sleep quality and paranoia across the paranoia continuum: An experience sampling study.

Sleep disturbances are prevalent among individuals with a psychotic disorder and have been linked to symptoms of paranoia across the entire psychosis continuum. Emerging evidence suggests that rather than a secondary symptom, poor quality of sleep may contribute to elevated paranoid ideation. We investigated the temporal dynamics of sleep quality and paranoid ideation using the experience sampling method in 42 acutely paranoid individuals with a psychotic disorder, 32 nonparanoid individuals with psychotic disorder, and 41 individuals with high schizotypy traits. We applied time-lagged mixed multilevel modeling to tease apart the effect of poor sleep quality on morning paranoia and negative affect, and the impact of evening paranoid ideation and negative affect on subsequent sleep quality. In the whole sample, poor subjective sleep quality predicted elevated paranoia the following morning, a relationship that was fully mediated by morning negative affect. No significant association between evening paranoia and poor sleep the following night emerged. In the everyday lives of individuals on the paranoia continuum, low quality of sleep appears to drive paranoia through its impact on negative affect. These findings identify sleep quality as an important target of transdiagnostic interventions for psychotic and affective symptomatology. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Understanding the relationships between self-esteem, experiential avoidance, and paranoia: structural equation modelling and experience sampling studies.

Hypothesized relationships between experiential avoidance (EA), self-esteem, and paranoia were tested using structural equation modeling in a sample of student participants (N = 427). EA in everyday life was also investigated using the Experience Sampling Method in a subsample of students scoring high (N = 17) and low (N = 15) on paranoia. Results showed that paranoid students had lower self-esteem and reported higher levels of EA than nonparanoid participants. The interactive influence of EA and stress predicted negative self-esteem: EA was particularly damaging at high levels of stress. Greater EA and higher social stress independently predicted lower positive self-esteem. Low positive self-esteem predicted engagement in EA. A direct association between EA and paranoia was also found. These results suggest that similar mechanisms may underlie EA and thought suppression. Although people may employ EA to regulate self-esteem, this strategy is maladaptive as it damages self-esteem, incurs cognitive costs, and fosters paranoid thinking.

Affective Instability and Alcohol Consumption: Ecological Momentary Assessment in an Adult Sample.

OBJECTIVE: The purpose of this study was to examine associations between three measures of affective instability (total affective instability [i.e., the sum of negative and positive affective instability], negative affective instability, and positive affective instability) and the likelihood and quantity of alcohol consumption in an adult community sample, within and between subjects. METHOD: Following an ecological momentary assessment protocol, 162 adults from the community (109 women, ages 20-50 years old, M = 36.07, SD = 9.23) reported their affect and alcohol consumption 10 times a day for 7 consecutive days on their smartphones. RESULTS: Within subjects, total affective instability was positively associated with likelihood and quantity of alcohol consumption. Separately, negative and positive affective instability were not associated with likelihood or quantity of alcohol consumption at the within-subject level. Total, negative, and positive affective instability were associated with neither likelihood nor quantity of alcohol consumption at the between-subject level. CONCLUSIONS: The results suggest that consuming alcohol in response to affective instability was a within-person process, and that higher than a person's average levels of negative and positive affective instability may have a cumulative effect. Personalized interventions should identify days when affective instability is elevated and provide alternative, adaptive strategies for coping with emotional dysregulation. These interventions need to target instability in both negative and positive affect to counter their cumulative effect on alcohol consumption.

Fluctuations in self-esteem and paranoia in the context of daily life.

Studies investigating the relationship between self-esteem and paranoia have specifically focused on self-esteem level, but have neglected the dynamic aspects of self-esteem. In the present article, the authors investigated the relationship between self-esteem and paranoia in two different ways. First, 154 individuals ranging across the continuum in level of paranoia were studied with the Experience Sampling Method (a structured self-assessment diary technique) to assess the association between trait paranoia and level and fluctuation of self-esteem in daily life. Results showed that trait paranoia was associated with both lower levels and higher instability of self-esteem. Second, the temporal relationship between momentary (state) paranoia and self-esteem was investigated in the daily life of these individuals. Results showed that a decrease in self-esteem was associated with an immediate increase in paranoia. The findings indicate that paranoid individuals are not only characterized by a lower level of self-esteem but also by more fluctuations in their self-esteem and that fluctuations in self-esteem predict the degree of subsequent paranoia. These results are consistent with the hypothesis that paranoia is associated with dysfunctional strategies of self-esteem regulation.

Affect and between-meal snacking in daily life: the moderating role of gender and age.

OBJECTIVE: Affect-related energy intake from snacks remains relatively unexplored in daily life. This study examines the associations between momentary positive affect (PA) and momentary negative affect (NA) and subsequent energy intake from snacks. In addition, the moderating role of BMI, gender, age and level of education is investigated. DESIGN: Adults (N = 269), aged 20-50, participated in this study. Demographics were assessed in an online composite questionnaire. An experience sampling smartphone application was used to map momentary NA/PA and energy intake (kilocalories) from snacks in the context of daily life. MAIN OUTCOME MEASURES: Energy intake from moment-to-moment self-reported snacks in real-life settings. RESULTS: A significant negative main effect of momentary NA on moment-to-moment energy intake was found. The higher the momentary NA, the lower the subsequent amount of kilocalories consumed. There was no main effect with regard to PA. Interaction analyses showed that men decreased their energy intake after experiencing NA, and increased their intake after experiencing PA. No associations were found in women. Additionally, young adults (20-30) increased their energy intake after experiencing PA. No associations were found in the other age groups. CONCLUSION: Interventions aiming at reducing energy intake might also address PA-related snacking in young adults and men.

Negative affective stress reactivity: The dampening effect of snacking.

The present study sets out to further elucidate the complex relationship between daily hassles, snacking, and negative affect (NA). The aim of the present study was to examine whether or not moment-to-moment energy intake from snacks moderates the association between momentary stress and NA. And, if so, can this moderating effect be replicated by using the amount of macronutrient intake (i.e., carbohydrates, fat, and protein) as moderator on the association between momentary stress and NA? Adults (N = 269), aged 20-50 years, participated in this study. Stress, NA, and snack intake were assessed 10 times a day for 7 consecutive days in daily life with an experience sampling smartphone application. Multilevel regression analyses were performed to assess the hypothesized associations. Our study revealed a dampening effect of snacking on negative affective stress reactivity. However, this dampening effect could not be replicated by the amount of macronutrient intake from snacks. On the contrary, the amount of carbohydrates has an enhancing effect on negative affective stress reactivity. In the end, our study suggests that the critical question is which mechanisms are decisive in the dampening role of snacking on stress reactivity. A multidisciplinary approach may provide a full perspective.

Mild hearing impairment and psychotic experiences in a normal aging population.

BACKGROUND: Hearing impairment (HI) in the elderly may be a risk factor for psychosis, but associations between HI and psychotic disorder or psychotic experiences have been reported more consistently in younger than in older populations. The aims of this study were to replicate the positive association between hearing impairment and psychotic experiences and to clarify any differences between groups of young and old individuals in a non-clinical, normal aging general population sample. METHODS: HI, assessed at baseline and at 3-year follow-up, and psychotic experiences, assessed at 3-year follow-up, were analysed in a group of 848 individuals aged 33 to 89 years between 1999 and 2004. HI was determined on the basis of both self-report and audiometric examination. The "psychoticism" and "paranoid ideation" subscales from the SCL-90-R were used to assess level of psychotic experiences. RESULTS: Self-reported hearing problems expressed as conversational HI (beta=0.080, 95% CI: 0.23, 7.90, p=0.038) and subjective HI (beta=0.087, 95%CI: 0.70, 10.30, p=0.025), but not audiometric objective HI, were associated with psychotic experiences. In those with hearing aids, associations with psychotic experiences were only present if accompanied by self-reported hearing problems that persisted in spite of the hearing aid. In addition, HI increased the risk for psychotic experiences specifically in younger rather than older individuals. CONCLUSIONS: Self-reported hearing problems rather than audiometric or remediated hearing loss may contribute to the development of psychotic experiences in younger rather than in older individuals.

Hearing impairment and psychosis: a replication in a cohort of young adults.

Previous work has demonstrated an association between hearing impairment and psychosis. In the current study, this association was studied in a cohort of young people. In addition, it was studied to what degree duration of hearing problems (i.e. onset earlier in life) impacted on risk. Data were derived from the Greek National Perinatal Survey, a prospective birth cohort study of 11,048 neonates at baseline, 6594 seven-year olds at T1 and 3500 nineteen-year olds at T2. A significant association was found at age 19 years between the presence of hearing impairment and the presence of self-reported positive psychotic-like experiences (beta = 0.18, S.E. = 0.02, p < 0.000). In addition, this association was conditional on the duration of hearing problems, in that the association at age 19 years was stronger if hearing impairment had already been reported at age 7 years (test for interaction: p = 0.022). These results replicate previous findings of an association between hearing impairment and psychosis, extend it to the age range of late adolescence, and suggest that longer duration is associated with stronger risk.

Hearing impairment and psychosis revisited.

The previously reported but still poorly investigated link between deafness or hearing impairment (DHI) and the onset of positive psychotic experiences was investigated prospectively in a general population sample. Of the 109 DHI subjects at baseline, 11 (10.1%) displayed psychotic experiences at T(2) versus 137 (2.9%) of the non-DHI subjects (OR=3.8, 95% CI: 2.0, 7.2). This effect size was only slightly attenuated after adjustment for baseline psychotic experiences (OR=3.2, 95% CI: 1.6, 6.5) and after adjustment for T(0) psychotic experiences and a range of other confounders (OR=3.0, 95% CI: 1.4, 6.2) These results confirm previous findings of an association between hearing impairments and psychosis and show that this association can also be found prospectively in a nonclinical population.

Emotional experience in negative symptoms of schizophrenia--no evidence for a generalized hedonic deficit.

BACKGROUND: Deficits in emotion processing are thought to underlie the key negative symptoms flat affect and anhedonia observed in psychotic disorders. This study investigated emotional experience and social behavior in the realm of daily life in a sample of patients with schizophrenia and schizoaffective disorder, stratified by level of negative symptoms. METHODS: Emotional experience and behavior of 149 patients with schizophrenia and schizoaffective disorder and 143 controls were explored using the Experience Sampling Method. RESULTS: Patients reported lower levels of positive and higher levels of negative affect compared with controls. High negative symptom patients reported similar emotional stability and capacity to generate positive affect as controls, whereas low negative symptom patients reported increased instability. All participants displayed roughly comparable emotional responses to the company of other people. However, in comparison with controls, patients showed more social withdrawal and preference to be alone while in company, particularly the high negative symptom group. CONCLUSIONS: This study revealed no evidence for a generalized hedonic deficit in patients with psychotic spectrum disorders. Lower rather than higher levels of negative symptoms were associated with a pattern of emotional processing which was different from healthy controls.

Mobile assessment in schizophrenia: a data-driven momentary approach.

In this article, a data-driven approach was adopted to demonstrate how real-life diary techniques [ie, the experience sampling method (ESM)] could be deployed for assessment purposes in patients with psychotic disorder, delivering individualized and clinically relevant information. The dataset included patients in an acute phase of psychosis and the focus was on paranoia as one of the main psychotic symptoms (30 patients with high levels of paranoia and 34 with low levels of paranoia). Based on individual cases, it was demonstrated how (1) symptom and mood patterns, (2) patterns of social interactions or activities, (3) contextual risk profiles (eg, is being among strangers, as opposed to family, associated with higher paranoia severity?), and (4) temporal dynamics between mood states and paranoia (eg, does anxiety precipitate or follow the onset of increased paranoia severity?) substantially differ within individual patients and across the high vs low paranoid patient group. Most striking, it was shown that individual findings are different from what is found on overall group levels. Some people stay anxious after a paranoid thought came to mind. For others, paranoia is followed by a state of relaxation. It is discussed how ESM, surfacing the patient's implicit knowledge about symptom patterns, may provide an excellent starting point for person-tailored psychoeducation and for choosing the most applicable therapeutic intervention.

Temporal dynamics of visual and auditory hallucinations in psychosis.

BACKGROUND: Hallucinations are a core feature of psychosis, often causing considerable distress. Reported prevalence ranges from 70% for auditory hallucinations (AHs) to 30% for visual hallucinations (VHs) and 4% for hallucinations in the tactile domain. AHs have been studied extensively but studies on VHs are scarce. The current study investigated the phenomenology of VHs and AHs in the realm of daily life, by analyzing their prevalence, course and co-occurrence over a 6-day period and their temporal relation to emotions and delusions. METHODS: The ESM, a structured diary technique, was used to investigate hallucinatory experiences in the context of daily life in a pooled data-set of 184 participants (71% males) with psychosis spectrum disorders, which were recruited from mental health facilities in the south of the Netherlands and Belgium. All self-assessments were rated on 7-point Likert scales. VHs were defined using participants' scores on the item "I see phenomena". AHs were measured using the item "I hear voices". RESULTS: Overall, 73 participants (40%) reported hallucinations. Ten participants reported VHs only, 38 reported both VHs and AHs, and 25 participants reported AHs only. AHs co-occurred with VHs in 40% of the hallucinatory moments. Patients with both VHs and AHs reported higher levels of negative affect, lower levels of positive affect and higher delusional intensity than non-hallucinating patients. Increased delusional intensity preceded the onset of hallucinatory episodes, whereas increases in positive or negative affect did not. DISCUSSION: These results show that VHs are common in patients with psychosis spectrum disorders and often co-occur with AHs in time. Furthermore delusional ideation may precede hallucinatory episodes in the realm of daily life, rather than result from a hallucination and affective dysregulation might not play a primary role in hallucination onset.