Understanding the Psychological Mechanism of Emotional Distress in Psychosis: The role of Goal Expectancy and Beliefs about Experience

Evidence suggests that emotional distress, including problems like depression and anxiety is commonly reported by individuals meeting criteria for psychosis spectrum disorders. It has been argued that the appraisals individuals hold about the meaning of their psychosis may explain the emotional distress experienced. However, this literature has often failed to acknowledge the role of other variables in accounting for this distress. The aim of this thesis was to investigate the mechanisms underpinning emotional distress in those experiencing psychosis, by focusing specifically on psychosis-related appraisals and goal expectancy. A total of five studies are reported, four of these addressed the above aim by focusing specifically on individuals with a psychosis related disorder who were receiving support from a rehabilitation service. The final study captured how parental carers make sense of their child’s future following an experience of psychosis. Following a review of the literature in Chapter One, Chapter Two aimed to provide an overview of the methodological approaches employed in the current thesis. The study presented in Chapter Three aimed to synthesis the literature investigating the association between appraisals of psychosis experience and emotional distress in those experiencing psychosis, in order to determine the direction and magnitude of this association. A total of 17 studies were included in the review (15 in the meta-analysis). Small to moderate associations were observed between appraisals of psychosis and both depression and anxiety. A narrative synthesis of the literature showed that significant associations were evident in a small number of longitudinal studies (with regards to depression only). Furthermore, i in a number of cross-sectional studies significant associations held even when accounting for symptoms of psychosis, suggesting that the association that beliefs have with distress may not be entirely explained by the shared association with psychosis symptom severity. Chapter Four presents the findings of a study that aimed to validate a goal generation task within individuals experiencing psychosis. Using behaviour sequence analysis, the utility of the task in capturing goal generation processes in those meeting criteria for psychosis was determined. The study highlighted that those experiencing psychosis were able to progress from lower to higher-order goals. Using a cross-sectional design, Chapter Five aimed to investigate the extent to which psychosis related appraisals and goal expectancies (goal likelihood and goal difficulty) could account for emotional distress in those experiencing psychosis. A total of 73 individuals accessing support from a rehabilitation service were recruited. Results revealed that appraisals of psychosis were significantly associated with depression and anxiety. Specifically, appraisals of psychosis as a source of internal shame and defectiveness, external shame and as resulting in loss (e.g., loss of future employments) were all found to predict both depression and anxiety. Many of these associations held when controlling for other variables. Only appraisals of internal shame and defectiveness were found to be significantly associated with emotional distress, however, this association did not hold when controlling for other variables. When adjusting for appraisals of psychosis, goal appraisals were not found to be significantly associated with emotional distress. Chapter Six aimed to expand upon the results presented in chapter five by investigating the longitudinal association between goal expectancies (goal likelihood, difficulty and progress) and emotional distress. A series of mixed model ii regression analyses were carried out to determine the concurrent association between the variable and to establish if the degree of change in goal appraisals would correspond with changes in depression scores. On the whole these models revealed that goal expectancies do not have a consistent association with emotional distress when adjusting for other factors. However, they did highlight that appraisals of psychosis may be implicated in emotional distress within individuals experiencing psychosis. Finally, Chapter Seven presents the findings of a qualitative paper. Nine parental carers were interviewed with the aim of exploring how they make sense of their child’s future following an experience of psychosis, focusing particularly on the goals and aspirations parental carers hold for their adult children. An interpretative phenomenological analysis was carried out. A total of three superordinate themes emerged, impact of psychosis (subthemes: psychosis causing a change of path, goals: lost, maintained and adjusted), a fear of relapse (subthemes: concerns about coping and adjustment), and navigating the future (subthemes: hope, uncertainty and somewhere in between, barriers and facilitators). Overall, the findings from the current thesis suggest that appraisals of psychosis experience are important in accounting for emotional distress, an effect that was observed consistently across the studies reported within this thesis. However, it appears that goal expectancies do not have a consistent effect with emotional distress.