Life hassles and delusional ideation: Scoping the potential role of cognitive and affective mediators

Cara Kingston, James Schuurmans-Stekhoven

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


Objectives: An intertemporal association between major psychological stress and subsequent delusion formation has been established by others. The current study explores (1) whether the stress from life hassles predicts delusional ideation and (2) if so, do self-criticism, self-reassurance, and positive and negative affectivity (PA and NA, respectively) mediate this link. This paper thus aimed to scope-out viable psychological processes involved in the formation of stress-induced delusions. 

Design: A cross-sectional survey using a non-clinical community sample. 

Methods: Responses (N = 251) to an online community survey were tested via a nonparametric bootstrap sampling approach to examine the effects of multiple mediators. 

Results: Self-criticism and NA appear to mediate a connection found between life hassles and delusions. A second mediation analysis found that life hassles positively predicts NA directly and indirectly (via self-criticism). NA in turn predicted delusional tendencies. Life events had direct statistical effects on delusions in all models. Neither PA nor self-reassurance mediated the stress-delusion link. 

Conclusions: Self-criticism and NA seem to be viable mediators worth contemplating when elaborating upon the connection between life hassles and delusions. Compared to self-criticism, NA appears to be the intervening variable most proximal to delusions and explains more variance. Even if these cross-sectional results were interpreted as causative, life hassles and delusions remained directly interconnected in all mediation models (suggesting much of the association remains unexplained). Although the results are theory-consistent, investigations using longitudinal, known-group, and experimental methods are now warranted to establish causation and possible feedback loops – especially from delusion to life hassles. Practitioner points: Self-criticism and negative affectivity (NA) mediate the link between stressful life events and delusions suggesting they might actively elicit delusional ideation, whereas self-reassurance and PA (although negatively associated with life hassles) have no unique predictive link to delusions. This study offers initial evidence that NA and self-criticism may be viable clinical intervention targets for early psychosis-sufferers under stress – especially for medically non-compliant and marginal (where drug treatment is not clinically indicated) cases. The clinical efficacy of alleviating self-criticism and/or negative emotional processes in those displaying early psychosis or at high risk appear worthy of exploration using both practice-based case studies and formal experimental research methods.

Original languageEnglish
Pages (from-to)445-463
Number of pages19
JournalPsychology and Psychotherapy: theory, research and practice
Issue number4
Publication statusPublished - 01 Dec 2016


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