Relationships between attachment insecurity, self-beliefs, beliefs about others, paranoia and social functioning across the psychosis continuum

Self-beliefs and beliefs about others are related to early attachment experiences and have been suggested to contribute to paranoid beliefs and social functioning difficulties in psychosis. Some evidence supports the relevance of self-beliefs, yet the role of beliefs about others has rarely been investigated. This study used the Experience Sampling Method (ESM) to examine relationships between attachment, beliefs about the self and others, paranoia, and social engagement across the psychosis continuum. The sample comprised 29 patients with a non-affective psychotic disorder (M age = 39.07, SD = 9.91, 20.68% female), 17 first-degree relatives (M age = 37.36, SD = 13.86, 64.71% female) and 26 control subjects (M age = 36.15, SD = 8.1, 34.6% female). Attachment insecurity (avoidance and anxiety) was assessed with the Psychosis Attachment Measure. Multilevel models were used to investigate cross-sectional and temporal relationships. Results suggest an important role of beliefs about the self with respect to attachment insecurity and suspiciousness. Negative self-beliefs mediated the association between attachment insecurity and paranoid beliefs. Attachment insecurity was unrelated to the amount of social contact. People who were more often alone held less positive self- and other regarding-beliefs, and being alone at a specific time was related to less positive momentary self-beliefs. Results showed that self- and other-regarding beliefs were related to higher levels of paranoia, highlighting their importance for cognitive interventions. These associations were present in all groups, supporting their utility as treatment targets in diverse therapeutic contexts.