MIXED METHODS INVESTIGATION OF DISTRESS RELATED TO PSYCHOSIS EXPERIENCES

Abstract

Distress associated with psychosis experiences has been related to the maintenance of psychosis experiences and people’s need for care. However, the mechanisms responsible for its maintenance remain unclear. Thus, this mixed methods project investigates experiential and psychological vulnerability factors contributing to distress related to psychosis in a clinical sample living in the community. This is done in order to determine whether specific vulnerability factors also act as maintenance factors for people in care. Therefore, these are assumed to be distinct. In the first study, a cross-sectional design (N= 60) was used to investigate the role of specific emotion regulation and metacognitive difficulties in the relationship between insecure attachment dimensions and distress related to psychosis experiences. Multiple regression analyses were conducted to determine which subscales predicted distress related to psychosis and significant predictors were taken forward to mediation models. Mediation analysis showed that only need for control mediated the relationship between insecure attachment and distress related to positive symptoms. Further, only limited access to emotion regulation strategies mediated the relationship between attachment anxiety and distress associated with both negative symptoms and to depressive symptoms in psychosis. These results expand on previous research by suggesting specific vulnerability factors that are related to distress associated with different symptoms. In the second study, Interpretative Phenomenological Analysis was used to analyse 10 in-depth qualitative interviews which explored people’s appraisals of their experiences of psychosis. Four inter-related themes emerged; (1)lacking control, (2)change – renegotiating a personal and social identity, (3)living in fear, and (4)multiple realities. The importance of ‘control’ is highlighted throughout all the themes, as negative appraisals about perceived control underpins experiences. This study demonstrates the importance of people’s appraisals to how they make meaning of and respond to psychosis experiences. Together, these studies emphasise that distress relates to psychosis experiences as a whole rather than specific symptoms. The two studies were integrated and interpreted using a joint display method. People’s perceived lack of control and unhelpful interpersonal relationships were found to contribute to the maintenance of distress related to psychosis experiences. Implications of these findings are discussed. Keywords: Psychosis, distress related to psychosis, emotion regulation, metacognition, attachment theory, mixed methods