Predictors of distress associated with psychotic-like anomalous experiences in clinical and non-clinical populations

ObjectivesPsychotic-like anomalous experiences are not inherently distressing, nor do they inevitably lead to clinical conditions. However, distress is an important predictor of onset and relapse in psychosis, and a primary indicator of problematic mental health. This study aimed to identify factors that predict distress across three groups with anomalous experiences. Design and methodsThis study used a cross-sectional design. Participants in Diagnosed' (n=35), At Risk' (n=20), and Undiagnosed' (n=36) groups completed the Appraisals of Anomalous Experiences Interview (AANEX; Brett etal., 2007, Br. J. Psychiatry, 191, s23), which taps anomalies experienced, appraisals, and other psychological and contextual variables. A series of ordinal logistic regression analyses was conducted to investigate which variables predicted anomaly-related distress. ResultsPredictors of higher distress were anomalous states characterized by changes in awareness and cognitive functioning (rather than more typical positive symptoms), appraisals of experiences as caused by other people', and greater attempted control over experiences. Predictors of lower distress were spiritual' appraisals, greater perceived social support/understanding, greater perceived controllability, and reacting with a neutral response'. ConclusionsWhile psychotic-like experiences themselves are not necessarily distressing, appraisals and responses to anomalies do predict distress, as do factors relating to the social context. This adds support to the cognitive-behavioural models, and continuum models, of positive psychotic symptoms. Practitioner points <list list-type="bulleted" id="bjc12036-list-0001"> The findings suggest that distress is reduced by developing normalizing and validating contexts in which psychotic experiences can be accepted, understood, and shared. Recommendation for delivering therapies that promote reappraising and/or accepting psychotic experiences, rather than attempting to control them. The findings reinforce the continuum model' of psychosis to help cultivate less stigmatizing, and more normalizing, views of psychotic experiences. A limitation is that the samples recruited cannot be assumed to be representative of all people experiencing psychotic-like anomalies. A further limitation is that a small number of AANEX items did not achieve satisfactory inter-rater agreement.