Self-esteem moderates affective and psychotic responses to social stress in psychosis: A virtual reality study

Alyssa Jongeneel*, Roos Pot-Kolder, Jacqueline Counotte, Mark van der Gaag, Wim Veling

*Corresponding author for this work

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Background: Higher liability to psychosis is associated with low self-esteem and increased sensitivity to social stress. Recently, we reported a positive relation between liability to psychosis and affective and psychotic responses to social stress. This study investigated how self-esteem moderates paranoia, peak subjective distress and stress reactivity of people with different psychosis liability in response to social stressors in virtual reality. Methods: Ninety-four individuals with lower (41 siblings and 53 controls) and 75 persons with higher psychosis liability (55 with recent onset psychotic disorder and 20 at ultra-high risk for psychosis) explored five times a virtual café with various social stressors (crowdedness, ethnic minority status, and hostility). They rated momentary paranoia (State Social Paranoia Scale) after each experiment and subjective distress on a visual analogue scale before and after the experiments. Positive and negative self-esteem were assessed with the Self-Esteem Rating Scale. Results: Momentary paranoia, peak subjective distress, and reactivity to social stressors were associated with negative self-esteem, but not positive self-esteem. Effects of both positive and negative self-esteem on psychotic and affective stress responses, but not stress reactivity, became significantly stronger when individuals were exposed to more stressful environments. Effects of self-esteem on momentary paranoia and peak subjective distress did not differ between the high liability and low liability group. Persons with lower psychosis liability had a stronger effect of negative self-esteem on stress reactivity than persons with higher liability. Conclusions: Positive and negative self-esteem may play an important role in affective and psychotic responses to social stress.

Original languageEnglish
Pages (from-to)80-85
Number of pages6
JournalSchizophrenia Research
Early online date27 Jun 2018
Publication statusPublished - Dec 2018


  • First episode
  • Psychoses
  • Risk factors
  • Schizophrenia
  • Social phobia


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