# The daily association between positive affect and psychotic experiences in individuals along the early stages of the psychosis continuum

## TL;DR

The study found that daily positive emotions and psychotic experiences are linked in people at early risk for psychosis, especially those at ultra-high risk.

## Contribution

This is the first study to show a bidirectional daily relationship between positive affect and psychotic experiences in early psychosis stages.

## Key findings

- Current-day positive affect predicts current-day psychotic experiences and vice versa.
- Higher positive affect over 90 days is associated with fewer psychotic experiences.
- The relationship between positive affect and psychotic experiences is stronger in ultra-high-risk individuals.

## Abstract

Psychosis often develops gradually along a continuum of severity. Little is known about the role of protective factors such as positive affect (PA) in the development of psychotic experiences (PEs). This study investigated i) the temporal (between-day) and contemporaneous (within-day) daily associations between PA and PEs in individuals at different early clinical stages for psychosis and ii) whether these associations differed per clinical stage.

Daily diary data for 90 days came from 96 individuals at risk for psychosis, distributed over four subgroups defined according to the clinical staging model (stages 0–1b). We constructed multilevel models with PA as a predictor of PEs and vice versa. We investigated within- and between-person temporal and contemporaneous associations and tested whether these associations differed among early stages with multilevel moderation analyses.

We found no within-person temporal effects between PA and PEs in either direction. Contemporaneously, current-day PA predicted current-day PEs (B = −0.14, p < 0.001) and vice versa (B = −0.61, p < 0.001). Between persons, more 90-day PA predicted fewer PEs in the temporal model (B = −0.14, p = 0.03). In addition, more 90-day PEs predicted PA in the temporal (B = −0.26, p < 0.001) and contemporaneous (B = −0.36, p < 0.001) models. The contemporaneous association between PA and PEs was stronger in individuals at ultra-high risk (UHR) for psychosis than in earlier stages.

Our study supported a significant within-day, bidirectional relationship between PA and PEs. This suggests that a focus on PA and methods to improve PA may be an important addition to early intervention practices, particularly in those at UHR for psychosis.