The role of safety-seeking behaviours in maintaining threat appraisals in psychosis

AimThis study investigated the interaction between appraisals and safety behaviours in the maintenance of psychotic symptoms.MethodThe study recruited a population who had persistent psychotic experiences but who had no ‘need-for-care’ (Persistence group; n = 39) as well as a population who had a diagnosed psychotic disorder and were receiving current treatment (Impairment group; n = 28). The participants were assessed on semi-structured interviews of appraisals and safety behaviours and on anxiety and depression questionnaires.ResultsThe two groups did not differ in total or first rank psychotic experiences, but the Persistence group showed less anomaly-related distress, depression and anxiety than the Impairment group. As predicted, the Impairment group displayed more threat appraisals and safety behaviours than the Persistence group, with a greater frequency of safety behaviours being related to higher levels of threat appraisals and anomaly-related distress. Threat appraisals mediated the relationship between safety behaviours and anomaly-related distress, suggesting that threat appraisals may maintain distress, a defining feature of Impairment status.ConclusionsThese data provide support for the cognitive model of psychosis in suggesting that cognitive and behavioural factors are key in differentiating non-clinical anomalous experiences from clinical psychotic status. These data suggest that therapy should target threat appraisals and safety-seeking behaviours in order to decrease distress.

► We recruited “need-for-care” (n = 39) and a “no-need-for-care” psychosis groups (n = 28).
► We examined threat appraisals, safety behaviours and anomaly related distress in both groups.
► Threat appraisals mediated the relationship between safety behaviours and anomaly-related distress.
► These data suggest that cognitive and behavioural factors differentiate non-clinical from clinical psychotic states.