The temporal association between social isolation, distress, and psychotic experiences in individuals at clinical high-risk for psychosis

Zeynep Akcaoglu, Thomas Vaessen*, Eva Velthorst, Ginette Lafit, Robin Achterhof, Barnaby Nelson, Patrick McGorry, Frederike Schirmbeck, Craig Morgan, Jessica Hartmann, Mark van der Gaag, Lieuwe de Haan, Lucia Valmaggia, Philip McGuire, Matthew Kempton, Henrietta Steinhart, Annelie Klippel, Wolfgang Viechtbauer, Tim Batink, Ruud van WinkelThérèse van Amelsvoort, Machteld Marcelis, Evelyne van Aubel, Ulrich Reininghaus, Inez Myin-Germeys, EU-GEI High Risk Study

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


BACKGROUND: Psychotic experiences (PEs) and social isolation (SI) seem related during early stages of psychosis, but the temporal dynamics between the two are not clear. Literature so far suggests a self-perpetuating cycle wherein momentary increases in PEs lead to social withdrawal, which, subsequently, triggers PEs at a next point in time, especially when SI is associated with increased distress. The current study investigated the daily-life temporal associations between SI and PEs, as well as the role of SI-related and general affective distress in individuals at clinical high risk (CHR) for psychosis. METHODS: We used experience sampling methodology in a sample of 137 CHR participants. We analyzed the association between SI, PEs, and distress using time-lagged linear mixed-effects models. RESULTS: SI did not predict next-moment fluctuations in PEs, or vice versa. Furthermore, although SI-related distress was not predictive of subsequent PEs, general affective distress during SI was a robust predictor of next-moment PEs. CONCLUSIONS: Our results suggest that SI and PEs are not directly related on a moment-to-moment level, but a negative emotional state when alone does contribute to the risk of PEs. These findings highlight the role of affective wellbeing during early-stage psychosis development.
Original languageEnglish
Number of pages9
JournalPsychological Medicine
Early online date5 Jan 2024
Publication statusE-pub ahead of print - 5 Jan 2024


  • Clinical high-risk
  • Distress
  • Experience sampling methodology
  • Negative affect
  • Psychotic experiences
  • Social isolation
  • Solitary stress


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