|dc.description.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
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
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||en