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Appraisals, psychotic symptoms and affect in daily life

Published online by Cambridge University Press:  13 September 2011

E. Peters*
King's College London, Institute of Psychiatry, Department of Psychology, London, UK
T. Lataster
University of Maastricht, Maastricht, The Netherlands
K. Greenwood
Sussex University, Department of Psychology, Brighton, UK
E. Kuipers
King's College London, Institute of Psychiatry, Department of Psychology, London, UK
J. Scott
Newcastle University, Institute of Neuroscience, Academic Psychiatry, UK
S. Williams
King's College London, Institute of Psychiatry, Department of Psychology, London, UK
P. Garety
King's College London, Institute of Psychiatry, Department of Psychology, London, UK
I. Myin-Germeys
University of Maastricht, Maastricht, The Netherlands
*Address for correspondence: Dr E. Peters, PO77, Psychology Department, King's College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. (Email:



Psychological models of psychosis were examined using Experience Sampling Methods (ESM) to explore relationships between dimensions and appraisals of key symptoms and affect.


Individuals were signalled to complete ESM booklets 10 times per day for six consecutive days; 534 data points were obtained from 12 out-patients with psychosis.


Although only 3.6% of spontaneous thoughts were psychosis related, these predicted more negative and less positive affect. Delusions and hallucinations, when present, were rated at a moderate level of intensity, and intensity was associated with distress, interference and preoccupation. Symptom dimensions were related to each other, with weaker associations with delusional conviction, which, it is hypothesized, may represent a separate factor. Conviction and appraisals relating to insight and decentring (‘my problems are something to do with the way my mind works’) were highly variable. Decentring appraisals of delusions, but not insight, were associated with less distress. Appraisals about the power of voices were strong predictors of negative affect and symptom distress.


This study demonstrates that ESM is a useful methodology to capture ‘online’ variability in psychotic phenomenology and provides evidence supporting cognitive models, which posit that psychotic symptoms are multi-dimensional phenomena, shaped by appraisals that, in turn, predict their emotional and behavioural sequelae.

Original Articles
Copyright © Cambridge University Press 2011

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Andreasen, NC (1989). Scale for the Assessment of Negative Symptoms (SANS). British Journal of Psychiatry (Suppl.) 155, S53S58.Google Scholar
Bach, P, Hayes, SC (2002). The use of acceptance and commitment therapy to prevent the rehospitalization of psychotic patients: a randomized controlled trial. Journal of Consulting and Clinical Psychology 70, 11291139.Google Scholar
Beck, AT, Epstein, N, Brown, G, Steer, RA (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology 56, 893897.Google Scholar
Beck, AT, Steer, RA, Brown, GK (1996). Manual for the Beck Depression Inventory, 2nd edn. The Psychological Corporation: San Antonia, Texas.Google Scholar
Bentall, RP (1990). The illusion of reality: a review and integration of psychological research on hallucinations. Psychological Bulletin 107, 8295.Google Scholar
Bentall, RP, Corcoran, R, Howard, R, Blackwood, N, Kinderman, P (2001). Persecutory delusions: a review and theoretical integration. Clinical Psychology Review 21, 11431192.Google Scholar
Bentall, RP, Fernyhough, C, Morrison, AP, Lewis, S, Corcoran, R (2007). Prospects for a cognitive-developmental account of psychotic experiences. British Journal of Clinical Psychology 46, 155173.Google Scholar
Bentall, RP, Jackson, HF, Pilgrim, D (1988). Abandoning the concept of ‘schizophrenia’: some implications of validity arguments for psychological research into psychotic phenomena. British Journal of Clinical Psychology 27, 303324.Google Scholar
Ben-Zeev, D, Ellington, K, Swendsen, J, Granholm, E (2010). Examining a cognitive model of persecutory ideation in the daily life of people with schizophrenia: a computerized experience sampling study. Schizophrenia Bulletin, doi:10.1093/schbul/sbq041, published online 11 May 2011.Google Scholar
Birchwood, M, Meaden, A, Trower, P, Gilbert, P, Plaistow, J (2000). The power and omnipotence of voices: subordination and entrapment by voices and significant others. Psychological Medicine 30, 337344.Google Scholar
Boyle, M (2002). Schizophrenia: A Scientific Delusion? 2nd edn. New York: Routledge.Google Scholar
Brett, CMC, Peters, ER, Johns, LC, Tabraham, P, Valmaggia, L, McGuire, P (2007). The appraisals of anomalous experiences interview (AANEX): a multi-dimensional measure of psychological responses to anomalies associated with psychosis. British Journal of Psychiatry (Suppl.) 191, S23S30.Google Scholar
Brett-Jones, J, Garety, PA, Hemsley, D (1987). Measuring delusional experiences: a method and its application. British Journal of Clinical Psychology 26, 257265.Google Scholar
Chadwick, P, Birchwood, M (1994). The omnipotence of voices: a cognitive approach to auditory hallucinations. British Journal of Psychiatry 164, 190201.Google Scholar
Chadwick, P, Hughes, S, Russell, D, Russell, I, Dagnan, D (2009). Mindfulness groups for distressing voices and paranoia: a replication and randomized feasibility trial. Behavioural and Cognitive Psychotherapy 37, 403412.Google Scholar
Cohen, J (1988). Statistical Power Analysis for the Behavioral Sciences. Lawrence Earlbaum Associates: Hillsdale, NY.Google Scholar
Cooke, MA, Peters, ER, Greenwood, KE, Fisher, PL, Kumari, V, Kuipers, E (2007). Insight in psychosis: the influence of cognitive ability and self-esteem. British Journal of Psychiatry 191, 234237.Google Scholar
Csikszentmihalyi, M, Larson, R (1987). Validity and reliability of the Experience-Sampling Method. Journal of Nervous & Mental Diseases 175, 526536.Google Scholar
Csipke, E, Kinderman, P (2006). A longitudinal investigation of beliefs about voices. Behavioural and Cognitive Psychotherapy 34, 365369.Google Scholar
Daalman, K, Boks, M, Diederen, K, de Weijer, AD, Blom, JD, Kahn, R, Sommer, I (2011). Same or different? Auditory verbal hallucinations in healthy and psychotic individuals. Journal of Clinical Psychiatry 72, 320325.Google Scholar
David, AS (1990). Insight and psychosis. British Journal of Psychiatry 156, 798808.Google Scholar
Delespaul, P, deVries, M (1987). The daily life of ambulatory chronic mental patients. Journal of Nervous & Mental Disease 175, 537544.Google Scholar
Delespaul, P, deVries, M, van Os, J (2002). Determinants of occurrence and recovery from hallucinations in daily life. Social Psychiatry & Psychiatric Epidemiology 37, 97–104.Google Scholar
Fowler, D, Garety, PA, Kuipers, E (1995). Cognitive Behaviour Therapy for Psychosis: Theory and Practice. Wiley: Chichester.Google Scholar
Freeman, D, Garety, PA, Kuipers, E (2001). Persecutory delusions: developing the understanding of belief maintenance and emotional distress. Psychological Medicine 31, 12931306.Google Scholar
Freeman, D, Garety, P, Kuipers, E, Fowler, D, Bebbington, P (2002). A cognitive model of persecutory delusions. British Journal of Clinical Psychology 41, 331347.Google Scholar
Garety, PA, Bebbington, PE, Fowler, D, Freeman, D, Kuipers, E (2007). Implications for neurobiological research of cognitive models of psychosis: a theoretical paper. Psychological Medicine 37, 13771391.Google Scholar
Garety, PA, Freeman, D, Jolley, S, Dunn, G, Bebbington, PE, Fowler, DG, Kuipers, E, Dudley, R (2005). Reasoning, emotions, and delusional conviction in psychosis. Journal of Abnormal Psychology 114, 373384.Google Scholar
Garety, PA, Hemsley, DR (1987). Characteristics of delusional experience. European Archives of Psychiatry and Neurological Sciences 236, 294298.Google Scholar
Garety, P, Hemsley, DR (1994). Delusions: Investigations into the Psychology of Delusional Reasoning. Maudsley Monographs 36. Oxford University Press: Hove.Google Scholar
Garety, PA, Kuipers, E, Fowler, D, Freeman, D, Bebbington, PE (2001). A cognitive model of the positive symptoms of psychosis. Psychological Medicine 31, 189195.Google Scholar
Granholm, E, Loh, C, Swendsen, J (2008). Feasibility and validity of computerized ecological momentary assessment in schizophrenia. Schizophrenia Bulletin 34, 507514.Google Scholar
Hacker, D, Birchwood, M, Tudway, J, Meaden, A, Amphlett, C (2008). Acting on voices: omnipotence, sources of threat, and safety-seeking behaviours. British Journal of Clinical Psychology 47, 201213.Google Scholar
Haddock, G, McCarron, J, Tarrier, N, Faragher, EB (1999). Scales to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS). Psychological Medicine 29, 879889.Google Scholar
Harrow, M, Rattenbury, F, Stoll, F (1988). Schizophrenic delusions: an analysis of their persistence, of related premorbid ideas and three major dimensions. In Delusional Beliefs (ed. Oltmanns, T. F. and Maher, B. A.). Wiley: New York.Google Scholar
Kimhy, D, Delespaul, P, Corcoran, C, Ahn, H, Yale, S, Malaspina, D (2006). Computerized experience sampling method (ESMc): assessing feasibility and validity among individuals with schizophrenia. Journal of Psychiatric Research 40, 221230.Google Scholar
Lovatt, A, Mason, O, Brett, C, Peters, E (2010). Psychotic-like experiences, appraisals, and trauma. Journal of Nervous and Mental Disease 198, 813819.Google Scholar
May, R (2000). Routes to recovery from psychosis: the roots of a clinical psychologist. Clinical Psychology Forum 146, 6–10.Google Scholar
Mintz, AR, Dobson, KS, Romney, DM (2003). Insight in schizophrenia: a meta-analysis. Schizophrenia Research 61, 7588.Google Scholar
Mizrahi, R, Kiang, M, Mamo, DC, Arenovich, T, Bagby, RM, Zipursky, RB, Kapur, S (2006). The selective effect of antipsychotics on the different dimensions of the experience of psychosis in schizophrenia spectrum disorders. Schizophrenia Research 88, 111118.Google Scholar
Morrison, AP (1998). A cognitive analysis of the maintenance of auditory hallucinations: are voices to schizophrenia what bodily sensations are to panic? Behavioural and Cognitive Psychotherapy 26, 289302.Google Scholar
Morrison, AP (2001). The interpretation of intrusions in psychosis: an integrative cognitive approach to hallucinations and delusions. Behavioural and Cognitive Psychotherapy 29, 257276.Google Scholar
Myin-Germeys, I, Delespaul, PA, deVries, MW (2000). Schizophrenia patients are more emotionally active than is assumed based on their behavior. Schizophrenia Bulletin 26, 847854.Google Scholar
Myin-Germeys, I, Delespaul, P, van Os, J (2005). Behavioural sensitization to daily life stress in psychosis. Psychological Medicine 35, 733741.Google Scholar
Myin-Germeys, I, Nicolson, NA, Delespaul, PA (2001 a). The context of delusional experiences in the daily life of patients with schizophrenia. Psychological Medicine 31, 489498.Google Scholar
Myin-Germeys, I, Oorschot, M, Collip, D, Lataster, J, Delespaul, P, van Os, J (2009). Experience sampling research in psychopathology: opening the black box of daily life. Psychological Medicine 39, 15331547.Google Scholar
Myin-Germeys, I, van Os, J, Schwartz, JE, Stone, AA, Delespaul, PA (2001 b). Emotional reactivity to daily life stress in psychosis. Archives of General Psychiatry 58, 11371144.Google Scholar
Oorschot, M, Kwapil, T, Delespaul, P, Myin-Germeys, I (2009). Momentary assessment research in psychosis. Psychological Assessment 21, 498505.Google Scholar
Peters, ER, Day, S, McKenna, J, Orbach, G (1999). The incidence of delusional ideation in religious and psychotic populations. British Journal of Clinical Psychology 38, 8396.Google Scholar
Peters, ER, Joseph, S, Day, S, Garety, PA (2004). Measuring delusional ideation: the 21-item PDI (Peters et al. Delusions Inventory). Schizophrenia Bulletin 30, 10051022.Google Scholar
Pitt, L, Kilbride, M, Nothard, S, Welford, M, Morrison, AP (2007). Researching recovery from psychosis: a user-led project. Psychiatric Bulletin 31, 5560.Google Scholar
Priebe, S, Huxley, P, Knight, S, Evans, S (1999). Application and results of the Manchester Short Assessment of Quality of Life (MANSA). International Journal of Social Psychiatry 45, 7–12.Google Scholar
Romme, MAJ, Escher, ADMA (1989). Hearing voices. Schizophrenia Bulletin 15, 209216.Google Scholar
Selten, JP, Sibjen, N, van sen Bosch, R, Omloo-Visser, J, Warmerdam, H (1993). The subjective experience of negative symptoms: a self-rating scale. Comprehensive Psychiatry 34, 192197.Google Scholar
Sharp, HM, Fear, CF, Williams, MG, Healy, D, Lowe, CF, Yeadon, H, Holden, R (1996). Delusional phenomenology—dimensions of change. Behaviour Research and Therapy 34, 123142.Google Scholar
Smith, L, Riley, S, Peters, ER (2009). Schizotypy, delusional ideation and well-being in an American New Religious Movement population. Clinical Psychology and Psychotherapy 16, 479484.Google Scholar
Stone, AA, Schwartz, JE, Neale, JM, Shiffman, S, Marco, CA, Hickcox, M, Paty, J, Porter, LS, Cruise, LJ (1998). A comparison of coping assessed by ecological momentary assessment and retrospective recall. Journal of Personality & Social Psychology 74, 16701680.Google Scholar
Tarrier, N, Sharpe, L, Beckett, R, Harwood, S, Baker, A, Yusupoff, L (1993). A trial of two cognitive-behavioural methods of treating drug-resistant residual psychotic symptoms in schizophrenic patients: II: treatment-specific changes in coping and problem-solving skills. Social Psychiatry & Psychiatric Epidemiology 28, 5–10.Google Scholar
Thewissen, V, Bentall, RP, Campo, J, van Lierop, T, van Os, J, Myin-Germeys, I (2011). Emotions, self-esteem and paranoid episodes: a longitudinal study using the Experience Sampling Method. British Journal of Clinical Psychology 50, 178195.Google Scholar
Thewissen, V, Bentall, RP, Lecomte, T, van Os, J, Myin-Germeys, I (2008). Fluctuations in self-esteem and paranoia in the context of daily life. Journal of Abnormal Psychology 117, 143153.Google Scholar
Trower, P, Birchwood, M, Meaden, A, Byrne, S, Nelson, A, Ross, K (2004). Cognitive therapy for command hallucinations: randomised controlled trial. British Journal of Psychiatry 184, 312320.Google Scholar
van Os, J, Gilvarry, C, Bale, R, van Horn, E, Tattan, T, White, I, Murray, R (1999). A comparison of the utility of dimensional and categorical representations of psychosis. Psychological Medicine 29, 595606.Google Scholar
Wiffen, B, Rabinowitz, J, Lex, A, David, AS (2010). Correlates, change and ‘state or trait’ properties of insight in schizophrenia. Schizophrenia Research 122, 94–103.Google Scholar
Zubin, J, Spring, B (1977). Vulnerability: a new view of schizophrenia. Journal of Abnormal Psychology 86, 103126.Google Scholar