TY - JOUR

T1 - A temporal network analysis of complex post-traumatic stress disorder and psychosis symptoms

AU - Panayi, Peter

AU - Contreras, Alba

AU - Peters, Emmanuelle

AU - Bentall, Richard

AU - Hardy, Amy

AU - Berry, Katherine

AU - Sellwood, William

AU - Dudley, Robert

AU - Longden, Eleanor

AU - Underwood, Raphael

AU - Steel, Craig

AU - Jafari, Hassan

AU - Mason, Liam

AU - Varese, Filippo

PY - 2025/2/20

Y1 - 2025/2/20

N2 - Symptoms of complex post-traumatic stress disorder (cPTSD) may play a role in the maintenance of psychotic symptoms. Network analyses have shown interrelationships between post-traumatic sequelae and psychosis, but the temporal dynamics of these relationships in people with psychosis and a history of trauma remain unclear. We aimed to explore, using network analysis, the temporal order of relationships between symptoms of cPTSD (i.e. core PTSD and disturbances of self-organization [DSOs]) and psychosis in the flow of daily life. Participants with psychosis and comorbid PTSD ( = 153) completed an experience-sampling study involving multiple daily assessments of psychosis (paranoia, voices, and visions), core PTSD (trauma-related intrusions, avoidance, hyperarousal), and DSOs (emotional dysregulation, interpersonal difficulties, negative self-concept) over six consecutive days. Multilevel vector autoregressive modeling was used to estimate three complementary networks representing different timescales. Our between-subjects network suggested that, on average over the testing period, most cPTSD symptoms related to at least one positive psychotic symptom. Many average relationships persist in the contemporaneous network, indicating symptoms of cPTSD and psychosis co-occur, especially paranoia with hyperarousal and negative self-concept. The temporal network suggested that paranoia reciprocally predicted, and was predicted by, hyperarousal, negative self-concept, and emotional dysregulation from moment to moment. cPTSD did not directly relate to voices in the temporal network. cPTSD and positive psychosis symptoms mutually maintain each other in trauma-exposed people with psychosis via the maintenance of current threat, consistent with cognitive models of PTSD. Current threat, therefore, represents a valuable treatment target in phased-based trauma-focused psychosis interventions.

AB - Symptoms of complex post-traumatic stress disorder (cPTSD) may play a role in the maintenance of psychotic symptoms. Network analyses have shown interrelationships between post-traumatic sequelae and psychosis, but the temporal dynamics of these relationships in people with psychosis and a history of trauma remain unclear. We aimed to explore, using network analysis, the temporal order of relationships between symptoms of cPTSD (i.e. core PTSD and disturbances of self-organization [DSOs]) and psychosis in the flow of daily life. Participants with psychosis and comorbid PTSD ( = 153) completed an experience-sampling study involving multiple daily assessments of psychosis (paranoia, voices, and visions), core PTSD (trauma-related intrusions, avoidance, hyperarousal), and DSOs (emotional dysregulation, interpersonal difficulties, negative self-concept) over six consecutive days. Multilevel vector autoregressive modeling was used to estimate three complementary networks representing different timescales. Our between-subjects network suggested that, on average over the testing period, most cPTSD symptoms related to at least one positive psychotic symptom. Many average relationships persist in the contemporaneous network, indicating symptoms of cPTSD and psychosis co-occur, especially paranoia with hyperarousal and negative self-concept. The temporal network suggested that paranoia reciprocally predicted, and was predicted by, hyperarousal, negative self-concept, and emotional dysregulation from moment to moment. cPTSD did not directly relate to voices in the temporal network. cPTSD and positive psychosis symptoms mutually maintain each other in trauma-exposed people with psychosis via the maintenance of current threat, consistent with cognitive models of PTSD. Current threat, therefore, represents a valuable treatment target in phased-based trauma-focused psychosis interventions.

KW - Young Adult

KW - Middle Aged

KW - experience sampling methodology

KW - Male

KW - disturbances of self-organization

KW - hallucinations

KW - Female

KW - Adult

KW - Psychotic Disorders - physiopathology

KW - Comorbidity

KW - paranoia

KW - visions

KW - Ecological Momentary Assessment

KW - Self Concept

KW - trauma

KW - Stress Disorders, Post-Traumatic - physiopathology

KW - Humans

U2 - 10.1017/S0033291725000030

DO - 10.1017/S0033291725000030

M3 - Journal article

C2 - 39973045

VL - 55

JO - Psychological Medicine

JF - Psychological Medicine

SN - 0033-2917

M1 - e43

ER -