Hardiness predicts mental health recovery during the COVID-19 pandemic.

OBJECTIVE: The COVID-19 pandemic has elicited wide-scale general psychological distress; however, longitudinal investigations are required to identify the critical resources that support individuals' adaptation to this type of unique situation over time. Hardiness, a cognitive trait that facilitates adaptation in the context of adversity and possible posttraumatic growth, may be particularly influential on mental health recovery during health disasters when other resources are not available or effective. METHOD: We tested the hypothesis that greater psychological hardiness prior to the pandemic would predict lower traumatic stress symptoms (TSSs) and loneliness early into the pandemic and decreases in TSSs and loneliness between early 2020 and late 2021. Predominantly ethnic minority (77% Latina/o/x or Asian American) female young adults (N = 80; Mage = 25 years; 88% female) attending a minority-serving public university completed a measure of hardiness in January 2020 as well as measures of pandemic-related TSSs and loneliness in April 2020, October 2020, and December 2021. RESULTS: Latent growth curve analyses indicated that hardiness was associated with lower initial loneliness as well as decreases in TSSs and loneliness over time. CONCLUSIONS: Consistent with previous research on adaptation to other potentially traumatic stressors, the current findings suggest that psychological hardiness may play a critical protective role during a global health disaster, both in terms of initial distress and changes in distress over time. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Test-retest reliability of an emotion maintenance task.

Research on working memory has suggested domain-specific components for visual, verbal, and spatial information, and more recently for emotion. Affective working memory has been proposed as the set of processes involved in the maintenance of emotions to guide behaviour. The current study examined the reliability of an emotion maintenance/affective working memory task over two experimental sessions separated by one week. Subjective accuracy based on individual ratings was found to correlate over time and was highest for negatively valenced pictures. Results suggest that this paradigm is a reliable measure of emotion maintenance, underscoring the utility of this measure as an assessment tool for normative and clinical populations.

Do cognitive impairments limit treatment gains in a standalone digital intervention for psychosis? A test of the digital divide.

Digital mental health interventions, such as those provided by smartphone applications (apps), show promise as cost-effective approaches to increasing access to evidence-based psychosocial interventions for psychosis. Although it is well known that limited financial resources can reduce the benefits of digital approaches to mental healthcare, the extent to which cognitive functioning in this population could impact capacity to engage in and benefit from these interventions is less studied. In the current study we examined the extent to which cognitive functioning (premorbid cognitive abilities and social cognition) were related to treatment engagement and outcome in a standalone digital intervention for social functioning. Premorbid cognitive abilities generally showed no association with aggregated treatment engagement markers, including proportion of notifications responded to and degree of interest in working on app content, though there was a small positive association with improvements in social functioning. Social cognition, as measured using facial affect recognition ability, was unrelated to treatment engagement or outcome. These preliminary findings suggest that cognitive functioning is generally not associated with engagement or outcomes in a standalone digital intervention designed for and with people with schizophrenia spectrum disorders.

Smartphone-based mobility metrics capture daily social motivation and behavior in schizophrenia.

Impaired social functioning contributes to reduced quality of life and is associated with poor physical and psychological well-being in schizophrenia, and thus is a key psychosocial treatment target. Low social motivation contributes to impaired social functioning, but is typically examined using self-report or clinical ratings, which are prone to recall biases and do not adequately capture the dynamic nature of social motivation in daily life. In the current study, we examined the utility of global positioning system (GPS)-based mobility data for capturing social motivation and behavior in people with schizophrenia. Thirty-one participants with schizophrenia engaged in a 60-day mobile intervention designed to increase social motivation and functioning. We examined associations between twice daily self-reports of social motivation and behavior (e.g., number of social interactions) collected via Ecological Momentary Assessment (EMA) and passively collected daily GPS mobility metrics (e.g., number of hours spent at home) in 26 of these participants. Findings suggested that greater mobility on a given day was associated with more EMA-reported social interactions on that day for four out of five examined mobility metrics: number of hours spent at home, number of locations visited, probability of being stationary, and likelihood of following one's typical routine. In addition, greater baseline social functioning was associated with less daily time spent at home and lower probability of following a daily routine during the intervention. GPS-based mobility thus corresponds with social behavior in daily life, suggesting that more social interactions may occur at times of greater mobility in people with schizophrenia, while subjective reports of social interest and motivation are less associated with mobility for this population.

Cross-cultural adaptation and psychometric evaluation of the Brazilian version of the Temporal Experience of Pleasure Scale (TEPS-Br).

INTRODUCTION: Anhedonia is a critical symptom of major depressive disorder that is defined as the reduced ability to experience pleasure. The Temporal Experience of Pleasure Scale (TEPS) is commonly used to measure anhedonia and has exhibited satisfactory reliability. OBJECTIVES: We aim to perform cross-cultural adaptation of a Brazilian version of the TEPS and evaluate its psychometric properties. METHOD: The cross-cultural adaptation was performed according to previously established protocols. Cronbach's alpha coefficient of internal consistency was used to establish the degree of interrelation and coherence of items. Also, we calculated the intraclass correlation coefficient to determine the stability of the scale after a proposed interval had elapsed and used exploratory factor analysis to evaluate the scale's factor structure and content validity. Principal component analysis was used to determine the factors to be retained in the factor model. RESULTS: The participants reported that the Brazilian version of the TEPS had good comprehensibility and applicability. The results revealed a statistically significant correlation between measures. The intraclass correlation coefficient calculated was significant. The Cronbach's alpha value calculated indicated that the scale's overall internal consistency was adequate. CONCLUSION: The Portuguese version of the TEPS scale proposed achieved good comprehensibility for the Brazilian population and its psychometric characteristics demonstrated good reliability and validity.

Evidence for an emotion maintenance deficit in schizophrenia.

Research has indicated that people with schizophrenia have deficits in reward representation and goal-directed behavior, which may be related to the maintenance of emotional experiences. Using a laboratory-based study, we investigated whether people with schizophrenia were able to maintain an emotional experience when given explicit instructions to do so. Twenty-eight people with schizophrenia and 19 people without completed a behavioral task judging their emotional experience of pictures held over a three second delay. This emotion maintenance task was compared to a subsequent in-the-moment emotion experience rating of each picture. In addition, all participants completed an analogous brightness experience maintenance and rating task, and patients completed a standardized visual working memory task. Participants with schizophrenia showed normal in-the-moment emotion experience of the emotion pictures; however, they showed decreased performance on emotion maintenance (for both positive and negative emotion) compared to participants without schizophrenia, even after controlling for brightness maintenance. The emotion maintenance deficit was not associated with visual brightness performance nor with performance on the visual working memory task; however, negative emotion maintenance was associated with an interview-based rating of motivation. These findings suggest that some aspects of impaired emotion maintenance in schizophrenia may be related to deficits in motivated behavior.

Preliminary Outcomes of an Ecological Momentary Intervention for Social Functioning in Schizophrenia: Pre-Post Study of the Motivation and Skills Support App.

BACKGROUND: People with schizophrenia and other serious mental illnesses often lack access to evidence-based interventions, particularly interventions that target meaningful recovery outcomes such as social functioning and quality of life. Mobile technologies, including smartphone apps, have the potential to provide scalable support that places elements of evidence-based interventions at the palm of patients' hands. OBJECTIVE: We aim to develop a smartphone app-called Motivation and Skills Support-to provide targeted social goal support (eg, making new friends and improving existing relationships) for people with schizophrenia enrolled in a stand-alone open trial. METHODS: In this paper, we presented preliminary outcomes of 31 participants who used the Motivation and Skills Support app for 8 weeks, including social functioning pre- to postintervention, and momentary reports of treatment targets (eg, social motivation and appraisals) during the intervention. RESULTS: The findings suggest that the intervention improved self-reported social functioning from baseline to treatment termination, particularly in female participants. Gains were not maintained at the 3-month follow-up. Furthermore, increased social functioning was predicted by momentary reports of social appraisals, including perceived social competence and the extent to which social interactions were worth the effort. CONCLUSIONS: The implications of these findings and future directions for addressing social functioning in schizophrenia using mobile technology have been discussed. TRIAL REGISTRATION: ClinicalTrials.gov NCT03404219; https://clinicaltrials.gov/ct2/show/NCT03404219.

Smartphone sensing of social interactions in people with and without schizophrenia.

Social impairment is a cardinal feature of schizophrenia spectrum disorders (SZ). Smaller social network size, diminished social skills, and loneliness are highly prevalent. Existing, gold-standard assessments of social impairment in SZ often rely on self-reported information that depends on retrospective recall and detailed accounts of complex social behaviors. This is particularly problematic in people with SZ given characteristic cognitive impairments and reduced insight. Ecological Momentary Assessment (EMA; repeated self-reports completed in the context of daily life) allows for the measurement of social behavior as it occurs in vivo, yet still relies on participant input. Momentary characterization of behavior using smartphone sensors (e.g., GPS, microphone) may also provide ecologically valid indicators of social functioning. In the current study we tested associations between both active (e.g., EMA-reported number of interactions) and passive (GPS-based mobility, conversations captured by microphone) smartphone-based measures of social activity and measures of social functioning and loneliness to examine the promise of such measures for understanding social impairment in SZ. Our results indicate that passive markers of mobility were more consistently associated with EMA measures of social behavior in controls than in people with SZ. Furthermore, dispositional loneliness showed associations with mobility metrics in both groups, while general social functioning was less related to these metrics. Finally, interactions detected in the ambient audio were more tied to social functioning in SZ than in controls. Findings speak to the promise of smartphone-based digital phenotyping as an approach to understanding objective markers of social activity in people with and without schizophrenia.

Development of the Motivation and Skills Support (MASS) social goal attainment smartphone app for (and with) people with schizophrenia.

People with schizophrenia and schizoaffective disorder (SZ) often struggle with social impairment, including small social networks and loneliness. Limitations in social skills and reduced social motivation-effort to engage in social connection-are key contributors to social impairment. While evidence-based approaches to improving social outcomes are available, including social skills training and cognitive behavioral therapy for psychosis, ongoing access to these interventions is often limited. Mobile technologies, including smartphone applications (apps), may address some of this need. In this paper, we describe the development of a smartphone app designed to address social skill and motivation deficits in SZ: the Motivation and Skills Support (MASS) app. We discuss the incorporation of stakeholder input into intervention design as well as results from usability pilot testing of the app in a sample of people with SZ. Finally, we describe next steps in the development and testing process of the MASS app.

How did that interaction make you feel? The relationship between quality of everyday social experiences and emotion in people with and without schizophrenia.

People with schizophrenia report positive emotion during social interactions in ecological momentary assessment (EMA) studies; however, few of these studies examine the qualities of social interactions (e.g., intimacy) that may affect emotion experience. In the current EMA study, people with (n = 20) and without schizophrenia (n = 15) answered questions about the quality of their social interactions, including their emotion experiences. We also explored the relationship between EMA-reported social experiences and trait loneliness, negative symptoms, and social functioning. People with and without schizophrenia did not differ in EMA-reported proportion of time spent with others, extent of involvement during social interactions, intimacy of interactions, or average number of social interactions. Both people with and without schizophrenia reported more positive than negative emotion during social experiences. However, people with schizophrenia reported more loneliness, more severe negative symptoms, and impaired social functioning compared to people without schizophrenia. Further, specific qualities of social interactions (intimacy of interaction, involvement during interaction) were related to happiness during interactions only in people without schizophrenia. These results suggest that while people with and without schizophrenia report similar rates of in-the-moment social emotion experiences, the impact of social interaction quality on emotion may differ between groups.

Social motivation in schizophrenia: How research on basic reward processes informs and limits our understanding.

Limited quantity and quality of interpersonal exchanges and relationships predict worse symptomatic and hospitalization outcomes and limit functional recovery in people with schizophrenia. While deficits in social skills and social cognition contribute to much of the impairment in social functioning in schizophrenia, our focus on the current review is social motivation-the drive to connect with others and form meaningful, lasting relationships. We pay particular attention to how recent research on reward informs, and limits, our understanding of the construct. Recent findings that parse out key components of human motivation, especially the temporal nature of reward and effort, are informative for understanding some aspects of social motivation. This approach, however, fails to fully integrate the critical influence of uncertainty and punishment (e.g., avoidance, threat) in social motivation. In the current review, we argue for the importance of experimental paradigms and real-time measurement to capture the interaction between social approach and avoidance in characterizing social affiliation in schizophrenia. We end with suggestions for how researchers might move the field forward by emphasizing the ecological validity of social motivation paradigms, including dynamic, momentary assessment of social reward and punishment using mobile technology and other innovative tools.

An investigation into the drivers of avolition in schizophrenia.

Over a century of research has documented that avolition is a core symptom in schizophrenia. However, the drivers of avolition remain unclear. Conceptually, there are at least two potential mutually compatible drivers that could cause avolition in schizophrenia. First, people with schizophrenia might have differences in preferences that result in less goal-directed behavior than non-clinical populations (preference-differences). Second, people with schizophrenia might have difficulty translating their preferences into manifest behavior at rates similar to non-clinical populations (psychological-inertia). In the present work, we modified and validated a well-validated paradigm from the motivation/decision making literature to compare levels of preference-differences and psychological-inertia. To measure preference-differences, people with and without schizophrenia choose between a lower-valenced and higher-valenced image. We measured the rate at which the normatively lower-valenced image was preferred. To measure psychological-inertia, both groups were given the opportunity to volitionally switch from a lower-valenced image and view a higher-valenced image. Contrary to expectations, people with schizophrenia did not differ on either preference-differences or psychological-inertia. Statistical analysis revealed that the possibility of a Type II error for even a weak effect was small. The present data suggest new avenues for research investigating mechanisms underlying avolition and clinical interventions targeting avolition in schizophrenia.

Psychometric evaluation of the Temporal Experience of Pleasure Scale (TEPS) in a German sample.

Anhedonia, or the inability to experience pleasure, is commonly observed in schizophrenia. It has been suggested that patients with schizophrenia are unable to predict future pleasurable events, but show intact experience of in-the-moment pleasure. Therefore, the Temporal Experience of Pleasure Scale (TEPS), a self-report measure allowing the assessment of anticipatory and consummatory pleasure, has been developed. To validate the German version of the TEPS, we recruited 59 healthy control participants and 51 patients with schizophrenia or schizoaffective disorder who completed the TEPS as well as a battery of psychometric tests to assess psychopathology, in particular self-rated anhedonia and clinician-rated apathy as well as overall measures of negative symptoms. We found acceptable to good internal consistency and a factor structure comparable to the original version. Scores of the TEPS were related to measures of anhedonia and apathy, but not with other measures of psychopathology. The present results suggest that the German version of the TEPS shows adequate reliability and validity to assess the construct of anhedonia. However, differential aspects of anticipatory and consummatory pleasure should be further investigated in clinical samples.

Anhedonia in schizophrenia: distinctions between anticipatory and consummatory pleasure.

Research on anhedonia in schizophrenia has revealed mixed results, with patients reporting greater anhedonia than healthy controls on self-report measures and semi-structured interviews, but also reporting comparable experiences of positive emotions in response to pleasurable stimuli. Basic science points to the importance of distinguishing between anticipatory and consummatory (or in-the-moment) pleasure experiences, and this distinction may help to reconcile the mixed findings on anhedonia in schizophrenia. In two studies, we tested the hypothesis that anhedonia in schizophrenia reflects a deficit in anticipatory pleasure but not consummatory pleasure. In Study 1, we used experience sampling methodology to assess reported experiences of consummatory and anticipated pleasure among schizophrenia patients and controls. In Study 2, schizophrenia patients and controls completed a self-report trait measure of anticipatory and consummatory pleasure and interviews that assessed negative symptoms, including anhedonia, and community functioning. In both studies, we found evidence for an anticipatory but not a consummatory pleasure deficit in schizophrenia. In addition, anticipatory pleasure was related to clinical ratings of anhedonia and functional outcome. Clinical and research implications of these findings are discussed.

Impact of motivational salience on affect modulated startle at early and late probe times.

This study systematically manipulated both picture content and noise probe time in order to evaluate the effects of motivational salience (as distinguished from affective valence) on both early and late modulation of the startle response. Specifically, modulation was compared for erotic versus action/adventure scenes, and for direct threat versus victim scenes, at early (300 and 800 ms) and late (3500 ms) probe times -- all relative to neutral. Blink inhibition was observed at all probe times during presentation of erotic pictures, and blink potentiation was evident at all times during presentation of direct threat pictures. Patterns of blink modulation were less consistent for action and victim picture contents. These findings are consistent with the hypothesis that under conditions of high motivational salience, affective startle modulation indexes the activation of appetitive-approach and defensive motivational states, even at early stages of picture processing.

Do people with schizophrenia experience more negative emotion and less positive emotion in their daily lives? A meta-analysis of experience sampling studies.

Research on emotion experience in response to valenced stimuli has consistently shown that people with schizophrenia have the capacity to experience emotion. Specifically, people with schizophrenia report similar experiences to both positive and negative emotion-eliciting stimuli as individuals without the disorder. However, it is less clear if people with schizophrenia experience similar levels of positive emotion and negative emotion outside of standardized laboratory contexts, as in their daily lives. One reliable method for assessing emotion experience in schizophrenia has been the Experience Sampling Method (ESM), or Ecological Momentary Assessment (EMA). Using the PRISMA guidelines for meta-analysis, we reviewed the literature for all studies that included people with and without schizophrenia, and that included a positive or negative emotion assessment during participants' daily lives. The current study is a meta-analysis of 12 EMA studies of emotion experience, which included a total of 619 people with schizophrenia and 730 healthy controls. Results indicate that people with schizophrenia consistently report more negative and less positive emotion than healthy control participants. These findings differ from laboratory-based studies, which may be due to several factors, including environmental differences, effects of the disorder that appear more clearly in daily life, or additional concerns, such as depression, which has been shown to be related to negative emotion in schizophrenia. Importantly, these findings are in line with questionnaire-based measures of emotion experience, lending some support for their use in research and clinical settings.

Cross-cultural adaptation and psychometric evaluation of the Brazilian version of the Temporal Experience of Pleasure Scale (TEPS-Br)

Abstract Introduction: Anhedonia is a critical symptom of major depressive disorder that is defined as the reduced ability to experience pleasure. The Temporal Experience of Pleasure Scale (TEPS) is commonly used to measure anhedonia and has exhibited satisfactory reliability. Objectives: We aim to perform cross-cultural adaptation of a Brazilian version of the TEPS and evaluate its psychometric properties. Method: The cross-cultural adaptation was performed according to previously established protocols. Cronbach's alpha coefficient of internal consistency was used to establish the degree of interrelation and coherence of items. Also, we calculated the intraclass correlation coefficient to determine the stability of the scale after a proposed interval had elapsed and used exploratory factor analysis to evaluate the scale's factor structure and content validity. Principal component analysis was used to determine the factors to be retained in the factor model. Results: The participants reported that the Brazilian version of the TEPS had good comprehensibility and applicability. The results revealed a statistically significant correlation between measures. The intraclass correlation coefficient calculated was significant. The Cronbach's alpha value calculated indicated that the scale's overall internal consistency was adequate. Conclusion: The Portuguese version of the TEPS scale proposed achieved good comprehensibility for the Brazilian population and its psychometric characteristics demonstrated good reliability and validity.

Assessing motivation orientations in schizophrenia: Scale development and validation.

Motivation deficits are common in several disorders including schizophrenia, and are an important factor in both functioning and treatment adherence. Self-Determination Theory (SDT), a leading macro-theory of motivation, has contributed a number of insights into how motivation is impaired in schizophrenia. Nonetheless, self-report measures of motivation appropriate for people with severe mental illness (including those that emphasize SDT) are generally lacking in the literature. To fill this gap, we adapted and abbreviated the well-validated General Causality Orientation Scale for use with people with schizophrenia and with other severe mental disorders (GCOS-clinical populations; GCOS-CP). In Study 1, we tested the similarity of our measure to the existing GCOS (using a college sample) and then validated this new measure in a schizophrenia and healthy control sample (Study 2). Results from Study 1 (N=360) indicated that the GCOS-CP was psychometrically similar to the original GCOS and provided good convergent and discriminant validity. In Study 2, the GCOS-CP was given to individuals with (N=44) and without schizophrenia (N=42). In line with both laboratory-based and observer-based research, people with schizophrenia showed lower motivational autonomy and higher impersonal/amotivated orientations. Additional applications of the GCOS-CP are discussed.

Modeling the role of negative symptoms in determining social functioning in individuals at clinical high risk of psychosis.

A priority for improving outcome in individuals at clinical high risk (CHR) is enhancing our understanding of predictors of psychosis as well as psychosocial functioning. Social functioning, in particular, is a unique indicator of risk as well as an important outcome in itself. Negative symptoms are a significant determinant of social functioning in CHR individuals; yet, it is unclear which specific negative symptoms drive functional outcome and how these symptoms function relative to other predictors, such as neurocognition and mood/anxiety symptoms. In a sample of 85 CHR individuals, we examined whether a two-factor negative symptom structure that is found in schizophrenia (experiential vs expressive symptoms) would be replicated in a CHR sample; and tested the degree to which specific negative symptoms predict social functioning, relative to neurocognition and mood/anxiety symptoms, which are known to predict functioning. The two-factor negative symptom solution was replicated in this CHR sample. Negative symptom severity was found to be uniquely predictive of social functioning, above and beyond depression/anxiety and neurocognition. Experiential symptoms were more strongly associated with social functioning, relative to expression symptoms. In addition, experiential symptoms mediated the relationship between expressive negative symptoms and social functioning. These results suggest that experiences of motivational impairment are more important in determining social functioning, relative to affective flattening and alogia, in CHR individuals, thereby informing the development of more precise therapeutic targets. Developing novel interventions that stimulate goal-directed behavior and reinforce rewarding experiences in social contexts are recommended.