Daily-life stress reactivity and recovery following virtual-reality-based cognitive behavioral therapy in patients with a psychotic disorder.

Introduction: Studies have consistently demonstrated increased stress sensitivity in individuals with psychosis. Since stress sensitivity may play a role in the onset and maintenance of psychosis, this could potentially be a promising target for treatment. The current study was the first to investigate whether reactivity to and recovery from daily-life stressors in psychosis change in response to treatment, namely virtual-reality-based cognitive behavioral therapy (VR-CBT). Methods: 116 patients were randomized to either VR-CBT or the waiting list control group (WL). Pre-treatment and post-treatment participants completed a diary ten times a day during six to ten days. Multilevel analyses were used to model the time-lagged effects of daily stressful events on negative affect (NA) and paranoia symptoms to examine reactivity and recovery. Results: There was a significant difference in NA reactivity. VR-CBT showed higher NA at post-treatment compared to pre-treatment than WL (bpre=0.14; bpost=0.19 vs bpre=0.18; bpost=0.14). There was a significant difference in NA recovery and paranoia recovery between the groups at lag 1: VR-CBT showed relatively lower negative affect (bpre=0.07; bpost=-0.06) and paranoia (bpre= 0.08; bpost=-0.10) at post-treatment compared to pre-treatment than WL (bpre=0.08; bpost=0.08; bpre=0.04; bpost=0.03). Conclusion: Negative affect and paranoia recovery improved in response to treatment. Increased NA reactivity may be explained by a decrease in safety behavior in the VR-CBT group. The discrepancy between reactivity and recovery findings may be explained by the inhibitory learning theory that suggests that an original threat reaction may not erase but can be inhibited as a consequence of exposure therapy.

Reflections on psychological resilience: a comparison of three conceptually different operationalizations in predicting mental health.

Background: Psychological resilience refers to the ability to maintain mental health or recover quickly after stress. Despite the popularity of resilience research, there is no consensus understanding or operationalization of resilience. Objective: We plan to compare three indicators of resilience that each involve a different operationalization of the construct: a) General resilience or one's self-reported general ability to overcome adversities; b) Daily resilience as momentarily experienced ability to overcome adversities; and c) Recovery speed evident in the pattern of negative affect recovery after small adversities in daily life. These three indicators are constructed per person to investigate their cross-sectional associations, stability over time, and predictive validity regarding mental health. Methods: Data will be derived from the prospective MIRORR study that comprises 96 individuals at different levels of psychosis risk and contains both single-time assessed questionnaires and 90-days intensive longitudinal data collection at baseline (T0) and three yearly follow-up waves (T1-T3). General resilience is assessed using the Brief Resilience Scale (BRS) at baseline. Daily resilience is measured by averaging daily resilience scores across 90 days. For recovery speed, vector-autoregressive models with consecutive impulse response simulations will be applied to diary data on negative affect and daily stressors to calculate pattern of affect recovery. These indicators will be correlated concurrently (at T0) to assess their overlap and prospectively (between T0 and T1) to estimate their stability. Their predictive potential will be assessed by regression analysis with mental health (SCL-90) as an outcome, resilience indicators as predictors, and stressful life events as a moderator. Conclusion: The comparison of different conceptualizations of psychological resilience can increase our understanding of its multifaceted nature and, in future, help improve diagnostic, prevention and intervention strategies aimed at increasing psychological resilience.

Antecedentes: La resiliencia psicológica se refiere a la habilidad de mantener la salud mental o recuperarse rápidamente después de estrés. A pesar de la popularidad de las investigaciones sobre resiliencia, no existe consenso respecto a la comprensión u operacionalización de la resiliencia.Objetivos: Planificamos comparar tres indicadores de resiliencia en que cada uno involucra una operacionalización diferente del constructo: a) Resiliencia general o la habilidad general autoreportada para superar adversidades; b) Resiliencia diaria como la habilidad experimentada momentáneamente para superar adversidades; y c) Velocidad de recuperación evidente en el patrón de recuperación de afecto negativo tras pequeñas adversidades en la vida diaria. Estos tres indicadores son construidos por persona para investigar sus asociaciones transversales, estabilidad sobre el tiempo, y validez predictiva sobre la salud mental.Métodos: Los datos serán derivados desde el estudio prospectivo MIRORR que comprende 96 individuos a diferentes riesgos de psicosis y contiene cuestionarios aplicados una sola vez y datos intensivos longitudinales colectados 90 días tras el punto de referencia (T0) y tres puntos de seguimiento anuales (T1­T3). La resiliencia general fue evaluada utilizando la Escala de Resiliencia Breve (BRS) al punto de referencia. La resiliencia diaria se mide promediando los puntajes de resiliencia diaria a lo largo de 90 días. Para la velocidad de recuperación, se aplicarán modelos vectoriales autorregresivos con simulaciones de respuestas de impulsos consecutivas a los datos diarios sobre afecto negativo y estresores diarios para calcular el patrón de recuperación afectiva. Estos indicadores se correlacionaran concurrentemente (en T0) para evaluar su superposición y prospectivamente (entre T0 y T1) para estimar su estabilidad. Su potencial predictivo se evaluara mediante un análisis de regresión con salud mental (SCL-90) como resultado, indicadores de resiliencia como predictores, y eventos vitales estresantes como moderador.Conclusión: La comparación de diferentes conceptualizaciones de la resiliencia psicológica puede aumentar nuestra comprensión sobre su naturaleza multifacética y, en el futuro, ayudar a mejorar estrategias de diagnóstico, prevención e intervención enfocadas a aumentar la resiliencia psicológica.

Overnight affective dynamics and sleep characteristics as predictors of depression and its development in women.

STUDY OBJECTIVES: We examined (1) differences in overnight affective inertia (carry-over of evening affect to the next morning) for positive (PA) and negative affect (NA) between individuals with past, current, and no depression; (2) how sleep duration and quality influence overnight affective inertia in these groups, and (3) whether overnight affective inertia predicts depression development. METHODS: We used data of 579 women from the East-Flanders Prospective Twin Survey. For aim 1 and 2, individuals with past (n = 82), current (n = 26), and without (lifetime) depression (n = 471) at baseline were examined. For aim 3, we examined individuals who did (n = 58) and did not (n = 319) develop a depressive episode at 12-month follow-up. Momentary PA and NA were assessed 10 times a day for 5 days. Sleep was assessed daily with sleep diaries. Affective inertia was operationalized as the influence of evening affect on morning affect. Linear mixed-effect models were used to test the hypotheses. RESULTS: Overnight affective inertia for NA was significantly larger in the current compared to the non-depressed group, and daytime NA inertia was larger in the past compared to the non-depressed group. Overnight NA inertia was differently associated with shorter sleep duration in both depression groups and with lower sleep quality in the current compared to the non-depressed group. Overnight affective inertia did not predict depression development at 12-month follow-up. CONCLUSIONS: Current findings demonstrate the importance of studying complex affect dynamics such as overnight affective inertia in relation to depression and sleep characteristics. Replication of these findings, preferably with longer time-series, is needed.

Network dynamics of momentary affect states and future course of psychopathology in adolescents.

BACKGROUND: Recent theories argue that an interplay between (i.e., network of) experiences, thoughts and affect in daily life may underlie the development of psychopathology. OBJECTIVE: To prospectively examine whether network dynamics of everyday affect states are associated with a future course of psychopathology in adolescents at an increased risk of mental disorders. METHODS: 159 adolescents from the East-Flanders Prospective Twin Study cohort participated in the study. At baseline, their momentary affect states were assessed using the Experience Sampling Method (ESM). The course of psychopathology was operationalized as the change in the Symptom Checklist-90 sum score after 1 year. Two groups were defined: one with a stable level (n = 81) and one with an increasing level (n = 78) of SCL-symptom severity. Group-level network dynamics of momentary positive and negative affect states were compared between groups. RESULTS: The group with increasing symptoms showed a stronger connections between negative affect states and their higher influence on positive states, as well as higher proneness to form 'vicious cycles', compared to the stable group. Based on permutation tests, these differences were not statistically significant. CONCLUSION: Although not statistically significant, some qualitative differences were observed between the networks of the two groups. More studies are needed to determine the value of momentary affect networks for predicting the course of psychopathology.

Don't worry, be happy: Protective factors to buffer against distress associated with psychotic experiences.

BACKGROUND: Around 6-7% of the general population report psychotic experiences (PEs). Positive PEs (e.g. hearing voices) may increase the risk of development of psychotic disorder. An important predictor of the transition to a psychotic disorder is secondary distress associated with PEs. We examined the moderating effect of potential protective factors on this secondary distress. METHODS: Data come from 2870 individuals of the HowNutsAreTheDutch study. PEs were assessed with the Community Assessment of Psychic Experience (CAPE) questionnaire and were divided into three subdomains ("Bizarre experiences", "Delusional ideations", and "Perceptual anomalies"). Protective factors explored were having a partner, having a pet, benevolent types of humor, optimism and the high levels of personality traits emotional stability (reversed neuroticism), extraversion, openness to experience, conscientiousness, and agreeableness. We examined whether these protective factors moderated (lowered) the association between frequency of PEs and PE-associated distress. RESULTS: Due to low prevalence of perceptual anomalies in the sample, this domain was excluded from analysis. No moderating effects were observed of protective factors on the association between bizarre experiences and distress. Having a partner and high levels of optimism, self-enhancing humor, openness, extraversion and emotional stability moderated the association between delusional ideations and secondary distress, leading to lower levels of distress. CONCLUSIONS: Several protective factors were found to moderate the association between frequency and secondary distress of delusional ideations, with high levels of the protective factors being associated with lower levels of distress. A focus on protective factors could be relevant for interventions and prevention strategies regarding psychotic phenomena.

Measuring resilience prospectively as the speed of affect recovery in daily life: a complex systems perspective on mental health.

INTRODUCTION: There is growing evidence that mental disorders behave like complex dynamic systems. Complex dynamic systems theory states that a slower recovery from small perturbations indicates a loss of resilience of a system. This study is the first to test whether the speed of recovery of affect states from small daily life perturbations predicts changes in psychopathological symptoms over 1 year in a group of adolescents at increased risk for mental disorders. METHODS: We used data from 157 adolescents from the TWINSSCAN study. Course of psychopathology was operationalized as the 1-year change in the Symptom Checklist-90 sum score. Two groups were defined: one with stable and one with increasing symptom levels. Time-series data on momentary daily affect and daily unpleasant events were collected 10 times a day for 6 days at baseline. We modeled the time-lagged effect of daily unpleasant events on negative and positive affect after each unpleasant event experienced, to examine at which time point the impact of the events is no longer detectable. RESULTS: There was a significant difference between groups in the effect of unpleasant events on negative affect 90 min after the events were reported. Stratified by group, in the Increase group, the effect of unpleasant events on both negative (B = 0.05, p < 0.01) and positive affect (B = - 0. 08, p < 0.01) was still detectable 90 min after the events, whereas in the Stable group this was not the case. CONCLUSION: Findings cautiously suggest that adolescents who develop more symptoms in the following year may display a slower affect recovery from daily perturbations at baseline. This supports the notion that mental health may behave according to the laws of a complex dynamic system. Future research needs to examine whether these dynamic indicators of system resilience may prove valuable for personalized risk assessment in this field.