Mentalizing under Stress and Psychotic Experiences: An Experience Sampling Study

Aim. Mentalizing difficulties and psychotic experiences are thought to be bidirectionally associated. Processes underlying mentalizing and psychosis may be stress-reactive and contextually activated but have been predominantly studied cross-sectionally. 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.Method. An analogue sample responded to self-report assessments of momentary mentalizing difficulties in understanding one’s feelings, negative affect, and psychotic experiences, using a one-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. Results. The recruited sample (n = 43) identified as 63% female, 21% male, and 16% non-binary with all participants aged between 18-38 years. Thirty percent 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. Conclusion. Mentalization 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 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.