Psychological medicine · 2026
Safety behaviors maintain persecutory ideation in individuals with psychotic disorders: evidence from an ecological momentary assessment study.
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Schönig Sven Niklas, Lincoln Tania Marie, Krkovic Katarina
Аннотация
BACKGROUND: Safety behaviors are a common response to persecutory ideation in psychosis. They potentially contribute to the maintenance and exacerbation of symptoms and emotional distress and are therefore a promising treatment target. However, empirical evidence for this hypothesized maintenance role is scarce. We therefore examined cross-sectional and micro-longitudinal associations between safety behaviors, negative affect, and persecutory ideation in the daily lives of individuals with psychotic disorders.
METHODS: We assessed safety behaviors, persecutory ideation, and negative affect at baseline and 10 times/day during one week of Ecological Momentary Assessment (EMA) in N = 64 participants with persecutory ideation and a psychotic disorder.
RESULTS: At baseline, safety behaviors were positively correlated with persecutory ideation (r = .47), depression (r = .67), and anxiety (r = .69). Safety behaviors assessed at baseline and safety behaviors assessed in daily life showed a moderate correlation (r = .56). Multilevel analyses of the longitudinal EMA data revealed persecutory ideation (β = .16) and negative affect (β = .11) to predict subsequent use of safety behaviors. Momentary use of safety behaviors predicted subsequent persecutory ideation (β = .13) and negative affect (β = .18).
CONCLUSIONS: Our results provide evidence for a vicious cycle of maintenance involving persecutory ideation, negative affect, and safety behaviors. Targeting safety behaviors with ecological momentary interventions in daily life could be a promising approach to interrupt this cycle.
METHODS: We assessed safety behaviors, persecutory ideation, and negative affect at baseline and 10 times/day during one week of Ecological Momentary Assessment (EMA) in N = 64 participants with persecutory ideation and a psychotic disorder.
RESULTS: At baseline, safety behaviors were positively correlated with persecutory ideation (r = .47), depression (r = .67), and anxiety (r = .69). Safety behaviors assessed at baseline and safety behaviors assessed in daily life showed a moderate correlation (r = .56). Multilevel analyses of the longitudinal EMA data revealed persecutory ideation (β = .16) and negative affect (β = .11) to predict subsequent use of safety behaviors. Momentary use of safety behaviors predicted subsequent persecutory ideation (β = .13) and negative affect (β = .18).
CONCLUSIONS: Our results provide evidence for a vicious cycle of maintenance involving persecutory ideation, negative affect, and safety behaviors. Targeting safety behaviors with ecological momentary interventions in daily life could be a promising approach to interrupt this cycle.