Psychological Medicine

Original Articles

Appraisals, psychotic symptoms and affect in daily life

E. Petersa1 c1, T. Latastera2, K. Greenwooda3, E. Kuipersa1, J. Scotta4, S. Williamsa1, P. Garetya1 and I. Myin-Germeysa2

a1 King's College London, Institute of Psychiatry, Department of Psychology, London, UK

a2 University of Maastricht, Maastricht, The Netherlands

a3 Sussex University, Department of Psychology, Brighton, UK

a4 Newcastle University, Institute of Neuroscience, Academic Psychiatry, UK


Background Psychological models of psychosis were examined using Experience Sampling Methods (ESM) to explore relationships between dimensions and appraisals of key symptoms and affect.

Method Individuals were signalled to complete ESM booklets 10 times per day for six consecutive days; 534 data points were obtained from 12 out-patients with psychosis.

Results Although only 3.6% of spontaneous thoughts were psychosis related, these predicted more negative and less positive affect. Delusions and hallucinations, when present, were rated at a moderate level of intensity, and intensity was associated with distress, interference and preoccupation. Symptom dimensions were related to each other, with weaker associations with delusional conviction, which, it is hypothesized, may represent a separate factor. Conviction and appraisals relating to insight and decentring (‘my problems are something to do with the way my mind works’) were highly variable. Decentring appraisals of delusions, but not insight, were associated with less distress. Appraisals about the power of voices were strong predictors of negative affect and symptom distress.

Conclusions This study demonstrates that ESM is a useful methodology to capture ‘online’ variability in psychotic phenomenology and provides evidence supporting cognitive models, which posit that psychotic symptoms are multi-dimensional phenomena, shaped by appraisals that, in turn, predict their emotional and behavioural sequelae.

(Received September 27 2010)

(Revised August 04 2011)

(Accepted August 08 2011)

(Online publication September 13 2011)


c1 Address for correspondence: Dr E. Peters, PO77, Psychology Department, King's College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. (Email:


† Joint last authors.

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