Do loneliness and social exclusion breed paranoia? An experience sampling investigation across the psychosis continuum

Media Use and Its Associations With Paranoia in Schizophrenia and Bipolar Disorder: Ecological Momentary Assessment

Background

Paranoia is a spectrum of fear-related experiences that spans diagnostic categories and is influenced by social and cognitive factors. The extent to which social media and other types of media use are associated with paranoia remains unclear.

Objective

We aimed to examine associations between media use and paranoia at the within- and between-person levels.

Methods

Participants were 409 individuals diagnosed with schizophrenia spectrum or bipolar disorder. Measures included sociodemographic and clinical characteristics at baseline, followed by ecological momentary assessments (EMAs) collected 3 times daily over 30 days. EMA evaluated paranoia and 5 types of media use: social media, television, music, reading or writing, and other internet or computer use. Generalized linear mixed models were used to examine paranoia as a function of each type of media use and vice versa at the within- and between-person levels.

Results

Of the 409 participants, the following subgroups reported at least 1 instance of media use: 261 (63.8%) for using social media, 385 (94.1%) for watching TV, 292 (71.4%) for listening to music, 191 (46.7%) for reading or writing, and 280 (68.5%) for other internet or computer use. Gender, ethnoracial groups, educational attainment, and diagnosis of schizophrenia versus bipolar disorder were differentially associated with the likelihood of media use. There was a within-person association between social media use and paranoia: using social media was associated with a subsequent decrease of 5.5% (fold-change 0.945, 95% CI 0.904-0.987) in paranoia. The reverse association, from paranoia to subsequent changes in social media use, was not statistically significant. Other types of media use were not significantly associated with paranoia.

Conclusions

This study shows that social media use was associated with a modest decrease in paranoia, perhaps reflecting the clinical benefits of social connection. However, structural disadvantage and individual factors may hamper the accessibility of media activities, and the mental health correlates of media use may further vary as a function of contents and contexts of use.

A Systematic Review of Momentary Social Predictors of Positive Psychosis Experiences

BACKGROUND

Social factors can play an important role in the development and maintenance of psychosis. Clarifying this relationship is vital for advancing theoretical understanding and development of targeted interventions. Psychosis is increasingly researched with an experience sampling methodology (ESM), which provides an ecologically valid approach, that reduces recall biases. Studies examining momentary associations between social factors and psychosis have not yet been summarised.

METHOD

We identified 29 ESM studies investigating associations between social factors and positive psychotic experiences through a pre-registered systematic search of the published literature.

RESULTS

Being alone did not predict increase in psychosis; however, appraisals and feelings associated with being alone such as feeling socially disconnected, lonely and unwanted did. Being with familiar company was found to reduce psychosis experiences but feeling stressed by the current company increased psychosis.

CONCLUSIONS

While issues with sample size and generalisability mean these results should be interpreted with caution, some putative conclusions can be made. Individuals with psychosis or emerging symptoms should be offered interventions that improve social networks such as peer support, community participation and engagement skills training. These individuals may also benefit from virtual reality or compassion-based interventions which aim to dampen perceived social threat. Moreover, digital interventions which monitor changes in social variables that predict relapse in symptoms would allow early intervention to prevent mental health crises.

Threatened by others or by everything? The effects of momentary and trait loneliness on daily appraisals of social company and being alone in young adults

Theoretical accounts of loneliness suggest that it may lead to psychopathological consequences by increasing the perception of social threat. However, it is unclear whether the real-life effects of both trait and state loneliness are specific to social situations. To answer this question, two experience sampling studies were conducted with prestratified samples of young adults (18-35) with moderate (Study 1, N = 64) or low and high (Study 2, N = 103) levels of loneliness. Participants were asked to report their emotional states and appraisals of social and nonsocial situations. Multilevel modelling of momentary and time-lagged associations revealed that trait loneliness was associated with less positive (Study 1) and more negative (Study 2) company appraisals. Importantly, in Study 2, trait loneliness was also related to less positive and more negative appraisals of being alone. Momentary loneliness was related to less positive and more negative appraisals of both types and predicted negative social appraisals over time in both studies. In Study 2, time-lagged interaction effects on social appraisals were found between the two levels. The results suggest that in highly lonely individuals, both levels of loneliness may lead to a general negativity bias and have a synergistic effect.

Methodological Characteristics and Feasibility of Ecological Momentary Assessment Studies in Psychosis: a Systematic Review and Meta-Analysis

BACKGROUND

Ecological momentary assessment (EMA) involves completing multiple surveys over time in daily life, capturing in-the-moment experiences in real-world contexts. EMA use in psychosis studies has surged over several decades. To critically examine EMA use in psychosis research and assist future researchers in designing new EMA studies, this systematic review aimed to summarize the methodological approaches used for positive symptoms in psychosis populations and evaluate feasibility with a focus on completion rates.

METHODS

A systematic review of PubMed, PsycINFO, MEDLINE, Web of Science, EBSCOhost, and Embase databases using search terms related to EMA and psychosis was conducted. Excluding duplicate samples, a meta-analysis was conducted of EMA survey completion rates and meta-regression to examine predictors of completion.

RESULTS

Sixty-eight studies were included in the review. Characteristics and reporting of EMA methodologies were variable across studies. The meta-mean EMA survey completion computed from the 39 unique studies that reported a mean completion rate was 67.15% (95% CI = 62.3, 71.9), with an average of 86.25% of the sample meeting a one-third EMA completion criterion. No significant predictors of completion were found in the meta-regression. A variety of EMA items were used to measure psychotic experiences, of which few were validated.

CONCLUSIONS

EMA methods have been widely applied in psychosis studies using a range of protocols. Completion rates are high, providing clear evidence of feasibility in psychosis populations. Recommendations for reporting in future studies are provided.

Changes of intuition in paranoid personality disorder

Wherever psychopathology operates with the concept of (disorders of) the self and personality, it can address the role of the intuitive access we have toward ourselves, others, and the world. This study discusses the concept of oikeiôsis. It examines its role in explaining paranoia as a change in intuitive self-and-world relatedness. In the first step, symptomatic features of paranoid personality disorder are sketched, with a focus on the explanatory role of attentional and interpretative biases, which correlate with significant changes in intuitive processing. In the second step, the prototypical phenomenality of feelings of unfamiliarity and mistrust are discussed against the backdrop of changes of oikeiôsis in paranoid personality disorder. In the third step, the main therapeutic challenge in treating paranoid personality disorder-building a trustful relationship-is explored. It is concluded that the notion of oikeiôsis resonates particularly with introspection-based therapeutic approaches.

The role of loneliness and negative schemas in the moment-to-moment dynamics between social anxiety and paranoia

Social anxiety and paranoia often co-occur and exacerbate each other. While loneliness and negative schemas contribute to the development of social anxiety and paranoia separately, their role in the development of the two symptoms co-occurring is rarely considered longitudinally. This study examined the moment-to-moment relationship between social anxiety and paranoia, as well as the effects of loneliness and negative schemas on both experiences individually and coincidingly. A total of 134 non-clinical young adults completed experience sampling assessments of momentary social anxiety, paranoia, and loneliness ten times per day for six consecutive days. Participants' negative-self and -other schemas were assessed with the Brief Core Schema Scale. Dynamic structural equation modelling revealed a bidirectional relationship between social anxiety and paranoia across moments. Loneliness preceded increases in both symptoms in the next moment. Higher negative-self schema was associated with a stronger link from paranoia to social anxiety; whereas higher negative-other schema was associated with a stronger link from social anxiety to paranoia. Our findings support the reciprocal relationship between social anxiety and paranoia. While loneliness contributes to the development of social anxiety and paranoia, negative self and other schemas appear to modify the relationships between the two symptoms.