Mentalizing under stress and psychotic experiences: An experience sampling study

Theoretical models identify stress-induced transient disruptions in the capacity to mentalize as a risk marker for psychosis yet there is little research that takes into account the context dependence of mentalizing and psychotic processes. To increase ecological validity, we investigated how mentalizing and psychotic experiences were concurrently and longitudinally associated in the flow of daily life, hypothesizing that mentalizing difficulties would predict both concurrent and subsequent presentations of psychotic experiences.

An analogue sample responded to self-report assessments of situational stress, momentary mentalizing difficulties in understanding one's feelings, negative affect and psychotic experiences, using a 1-week experience sampling schedule with eight measurement points per day. Concurrent and lagged associations between mentalization, negative affect and psychotic experiences were estimated via linear mixed effects and vector autoregressive modelling.

The analysed sample (n = 43) identified as 63% female, 21% male and 16% non-binary with all participants aged between 18 and 38 years. Thirty per cent of the sample self-reported a personal history of psychosis, and 37% were receiving mental health support. Significant concurrent and cross-lagged associations of positive effect sizes were identified between mentalizing difficulties and psychotic experience severity.

Mentalizing capacity may decline under stress and accordingly influence the severity and persistence of psychotic experiences. Our small sample size and the gender distribution may limit the generalizability of the findings. Future research should integrate interview- or performance-based metrics of mentalizing ability into longitudinal designs enabling more extensive examination of different domains of mentalizing difficulties and psychotic experiences.