Illness beliefs and psychological outcomes in people experiencing psychosis

Literature review

A systematic narrative review was undertaken to examine the link between illness beliefs about psychosis and distress from a critical standpoint. Three databases were searched and nineteen studies selected for review. Reviewed studies assessed links between illness beliefs in psychosis and distress, including low mood, anxiety, suicidality, quality of life and ‘recovery’. More negative illness beliefs were consistently associated with distress. Perceived entrapment by psychosis and loss of autonomy were strongly related to low mood, and perceived self-blame, stigma, shame and social status loss were strongly related to anxiety and social anxiety. Perceived consequences were strongly related to low mood, heightened anxiety, and increased suicidal ideation, and fewer perceived consequences were linked with better quality of life. Findings are discussed in relation to the self-regulation model and social ranking theory. Further longitudinal and qualitative research is needed to infer causality.

Empirical research project

There is a paucity of research into the causal beliefs of people experiencing psychosis and how these relate to psychological outcomes. Three-hundred-and-one participants diagnosed with ‘schizophrenia-related disorders’ completed a battery of assessments relating to causal beliefs, distress (anxiety, mood, self-esteem, unusual experiences) and other illness beliefs. A series of hierarchical regressions were performed using causal beliefs as predictors and distress and illness belief variables as criterion variables, whilst controlling for the impact of demographic variables. Causes relating to the self (e.g. ‘personality’) predicted worse distress, unusual experiences and illness beliefs. The causal belief ‘stress’ predicted worse self-esteem, and less frequent/distressing hallucinations (auditory and non-auditory). ‘Contamination’ beliefs predicted more frequent/distressing auditory hallucinations and perceptions of shorter timeline. Future research should include populations with unusual experiences who do not access mental health services. Causal beliefs should be explored sensitively and collaboratively between service users and healthcare professionals.