Mechanisms of self anomalies in people at risk of psychosis - the importance of traumatic experiences and cognitive distortions. Prospective study with a 12-month follow-up
Self anomalies, i.e. distortions in subjective experience of oneself and the outside world as well as self-awareness, are considered a key feature of psychotic disorders. According to some researchers, it is the self anomalies that underlie the development of psychotic symptoms, both positive and negative. The growing belief in the importance of these experiences for a full understanding of psychosis is also confirmed by the fact that they are included as a diagnostic criterion for schizophrenia in the beta version of the ICD-11 classification. Moreover, studies have shown that self anomalies are present not only among patients diagnosed with psychotic disorders, but also in healthy people with a high frequency of quasipsychotic experiences.
Quasi-psychotic experiences (PLEs) are phenomena that include, inter alia, delusional-like thoughts, or subclinical delusions or hallucinations about which a critical judgment is preserved, and phenomena related to an overly vivid imagination. It has long been postulated that positive psychotic symptoms lie on a continuum where psychotic disorders are at one end, and quasi-psychotic experiences at the other end.
Despite the undoubted importance of self anomaly for the conceptualization of psychosis, little is known about the prevalence of these disorders in the population and the underlying mechanisms. Nelson and his team (2014) proposed that a potential source of self anomaly may be cognitive distortions, i.e. dysfunctional patterns of information processing leading to maladaptive conclusions and emotional dysregulation. According to Nelson, one of the distortions that can contribute to self anomalies are source monitoring deficits. Source monitoring involves, for example, difficulties in distinguishing whether an event really happened, or whether we were just imagining it or someone told us about it. However, Nelson's hypothesis has not been extensively verified empirically so far. Moreover, there are also data suggesting that traumatic experiences may be at the root of self anomalies. Dysfunctional ways of coping with the experience of trauma may cause disturbances in the structure of the self and thus contribute to self anomalies such as loss of boundaries between oneself and the outside world or experiences of depersonalization. The aim of this project will be to verify the model according to which traumatic experiences and cognitive distortions underlie the development of self anomalies.
Prospective studies have shown that self anomalies make it possible to predict the onset of psychosis in a sample of people with a clinical state of very high risk of developing this disease, and thus can be used as an important tool for the early detection of the risk of developing psychotic disorders. However, there are no longitudinal studies that would verify the predictive value of self anomaly for the fluctuation of quasipsychotic symptoms over time and / or the development of psychosis in non-clinical (non-help) groups, but with a high frequency of PLEs.
The objectives of the study include:
1. Determination of the epidemiology of self anomaly in the population of people aged 18-35.
2. Determination of the mechanisms of self anomalies by examining their relationship with cognitive distortions and traumatic life events.
3. Longitudinal examination of self anomalies, i.e. re-evaluation of the respondents after 12 months to check whether the self anomalies predict fluctuations in the frequency of quasi-psychotic experiences and / or the development of psychosis.
The research will be carried out in three stages. In the first stage, screening will be carried out on a population of 6000 people aged 18–35 in order to estimate the prevalence of self anomaly in the non-clinical population (not seeking help) and to identify people at high risk of developing psychosis (high frequency of PLEs) (n = 200). The selected people (n = 200) will be invited to an experimental study (Fish Task, Action Memory Task and Overperceptualization Task) and questionnaires (CECA.Q, IPASE, DACOBS, PQ-16) assessing the occurrence of trauma and a wide spectrum of cognitive distortions. Additionally, with the help of structured interviews (CAARMS and SQUEASE), a comprehensive, multidimensional assessment of psychopathology (including self anomalies) will be carried out. Using the path analysis, the model of relationships between trauma and cognitive distortions and the intensity of self and PLEs anomalies will be tested. In the last stage (follow-up), after 12 months, a clinical reassessment of psychopathology will be carried out, thanks to which it will be possible to test the predictive value of the self anomaly model to predict the increase in PLEs and / or the occurrence of psychotic symptoms.
In addition, the control group (80 people) will also be examined, which will enable the comparison of the mechanisms of self anomalies and the dependencies of the studied variables in people with high and moderate amounts of PLEs.
The result of this project will be to fill the gap in the existing knowledge about the mechanisms of self anomalies. Thanks to the longitudinal study, it will also be possible to gain knowledge about the dynamics of these experiences and their importance in predicting the development of psychosis. The obtained results may supplement the models of therapy for people at high risk of developing psychosis, but also for people suffering from psychotic disorders. Self anomalies in the treatment of these patients have so far been rarely taken into account.