Perceived Burdensomeness and Thwarted Belongingness Prospectively Influence Real-World Social Support-Seeking Behavior Among Emerging Adults with First-Episode Psychosis

  1. Aubrey M Moe
  2. Xiaoxuan Cai
  3. Chenze Li
  4. Heather Wastler

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Abstract

Introduction: Social dysfunction is a core feature of first-episode psychosis (FEP) that broadly impacts effective interpersonal interaction. FEP often begins during emerging adulthood (i.e., the late teenage years into the early adult years), which is a critical period for development and maintenance of social relationships. Social support positively augments the early course of psychosis, yet little is known about factors that influence social support-seeking behavior in FEP. Notably, defeatist performance beliefs are prominent in psychotic disorders and interfere with goal-directed behavior. Though individuals with psychosis have elevated levels of negative social beliefs related to feeling like a burden to others (i.e., perceived burdensomeness; PB) and disconnection from others (i.e., thwarted belongingness; TB), how these beliefs impact perceptions of social support or support-seeking behavior is unknown. Methods: 42 participants with first-episode psychosis completed laboratory -based assessments of social relationships and negative social beliefs, followed by 4 weeks of ecological momentary assessment (EMA) to assess real-world engagement in social support-seeking behavior. Correlational analyses and generalized linear mixed-effect models were used to examine the contribution of PB and TB to both laboratory-based and real-world social perception and behavior. Results: Perceived burdensomeness (PB) and thwarted belongingness (TB) were negatively correlated with perceived social support. EMA revealed a within-person effect whereby individuals were most likely to seek social support when experiencing more negative affect than was typical of them. Finally, higher levels of baseline PB and TB were predictive of less social support-seeking behavior in everyday life. Conclusion: Negative interpersonal beliefs (i.e., PB and TB) are related to both perceptions of social support and real-world social support-seeking behavior in FEP. Beliefs about burdening others and individual-level variation in negative affect may be particularly impactful on social behavior. Collectively, our results highlight the relevance of interpersonal beliefs in predicting social behavior in FEP.

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  1. PREreview

    This Zenodo record is a permanently preserved version of a PREreview. You can view the complete PREreview at https://prereview.org/reviews/16636351.

    This study examined how negative social beliefs impact social support-seeking behaviour among 42 emerging adults with first-episode psychosis (FEP). The researchers found that perceived burdensomeness (PB) and thwarted belongingness (TB) - beliefs about being a burden to others and feeling disconnected from others - were negatively correlated with perceived social support at baseline. Utilizing four weeks of ecological momentary assessment (EMA), it was found participants were more likely to seek social support when experiencing higher than usual negative affect, and that baseline PB and TB prospectively predicted less social support-seeking behaviour in daily life. These findings suggest that PB and TB may be important therapeutic targets for improving social functioning in young people with psychosis, as social support positively augments the early course of psychosis.

    Major strengths

    ·       Novelty & Specificity - this paper is the first to demonstrate the prospective influence of specific negative social beliefs (e.g PB and TB), addressing a gap in understanding how negative cognitions translate into actual social behaviours. Rather than examining broad defeatist beliefs, the study focuses on specific interpersonal beliefs (PB and TB), which provides more targeted insights.

    ·       EMA Methodology - this allowed for the disentangling of within-person and between-person relationships, aiding understanding of how negative affect influences social behaviour in a way which would not have been apparent if only cross-sectional measures were utilized.  EMA results in real-time real-world data with higher ecological validity and reduced recall bias, and the study has a particularly high compliance rate, demonstrating its suitability in this clinical population.

    • Easy to follow- This paper was well-structured and clearly presented, making it an easy read. 

    Major issues

    ·       No major issues identified

    Minor issues/Suggestions

    ·       We recognise that writing papers involves a constant balancing act between being precise and accurate with language within a tight word count, while also aiming to keep the content accessible to readers outside the immediate field. That said, the introduction could benefit from slightly clearer explanations of key terms and more explicit statements of underlying assumptions linking arguments, to support researchers who may be newer to the area.

    ·       Use of secondary data – Although it is noted that this is a secondary analysis, it is not clear to the reader whether the analyses were preregistered, or the extent to which these analyses are exploratory in nature. Additionally, one hypothesis lacks clarity regarding directional expectations—the authors 'predicted that baseline PB and TB would prospectively influence social support-seeking behaviour', without specifying whether this influence would be positive or negative, or providing justification for why a non-directional hypothesis was appropriate given the theoretical framework suggesting negative social beliefs impair social functioning.

    ·       EMA item for social support – Although we recognise that the questionnaires were not selected by the authors for this specific analysis, the study could acknowledge the potential limitations of using only a single EMA item ("talking about your feelings to others") to assess social support-seeking behaviour, which may oversimplify this complex construct and limit the validity and clinical applicability of their findings.

    ·       EMA sampling strategy – The authors could provide further detail in regards to the timing blocks and scheduling parameters used for the pseudorandom delivery, and if there were minimum intervals between prompts.

    ·       Time variable – "Time" is included as a fixed effect in the statistical models but it is not explicit what this time variable represents i.e survey number, time since baseline etc.

    ·       Missing data - The paper reports 83.3% EMA compliance but does not explicitly describe how missing data is handled in their mixed-effects models, or consider the impact of factors affecting missingness.

    ·       Interaction analyses? – There is a line in the methods stating that 'Interactions between key variables were also explored.', however the Results section does not report any interaction analyses or findings. The authors should make it clear if these analyses were conducted but not reported, or if the Methods section includes planned analyses that weren't actually performed.

    ·       Terminology - The paper should not use the terms 'social support' and 'perceived social support' interchangeably.  

    ·       Figures: Inclusion of graphs or figures could help illuminate relationships between the key variables, and thus improve reader understanding.

    ·       Discussion/Clinical implications – The discussion section could perhaps benefit from greater focus and specificity. Although the paper does suggest that these negative social beliefs may be important targets for psychosocial interventions, this could be strengthened by inclusion of more specific therapeutic suggestions regarding techniques, implementation strategies, or how to differentially target perceived burdensomeness versus thwarted belongingness. The paragraph about understanding suicidality feels somewhat disconnected from the paper's primary focus on social support-seeking behaviour and while interesting, it introduces a new line of inquiry that wasn't directly examined in this study. This section could be condensed or moved to limitations/future directions to maintain focus on the core findings about social support-seeking.

    Competing interests

    The authors declare that they have no competing interests.

    Competing interests

    The authors declare that they have no competing interests.

  2. Version published to 10.31234/osf.io/54s3n_v1 on OSF Preprints