A temporal network analysis of complex post-traumatic stress disorder and psychosis symptoms

Peter Panayi; Alba Contreras; Emmanuelle Peters; Richard Bentall; Amy Hardy; Katherine Berry; William Sellwood; Robert Dudley; Eleanor Longden; Raphael Underwood; Craig Steel; Hassan Jafari; Liam Mason; Filippo Varese

doi:10.1017/S0033291725000030

A temporal network analysis of complex post-traumatic stress disorder and psychosis symptoms

Peter Panayi^*, Alba Contreras, Emmanuelle Peters, Richard Bentall, Amy Hardy, Katherine Berry, William Sellwood, Robert Dudley, Eleanor Longden, Raphael Underwood, Craig Steel, Hassan Jafari, Liam Mason, Filippo Varese

^*Corresponding author for this work

Psychology

Research output: Contribution to journal › Article › peer-review

Abstract

Background Symptoms of complex post-traumatic stress disorder (cPTSD) may play a role in the maintenance of psychotic symptoms. Network analyses have shown interrelationships between post-traumatic sequelae and psychosis, but the temporal dynamics of these relationships in people with psychosis and a history of trauma remain unclear. We aimed to explore, using network analysis, the temporal order of relationships between symptoms of cPTSD (i.e. core PTSD and disturbances of self-organization [DSOs]) and psychosis in the flow of daily life. Methods Participants with psychosis and comorbid PTSD (N = 153) completed an experience-sampling study involving multiple daily assessments of psychosis (paranoia, voices, and visions), core PTSD (trauma-related intrusions, avoidance, hyperarousal), and DSOs (emotional dysregulation, interpersonal difficulties, negative self-concept) over six consecutive days. Multilevel vector autoregressive modeling was used to estimate three complementary networks representing different timescales. Results Our between-subjects network suggested that, on average over the testing period, most cPTSD symptoms related to at least one positive psychotic symptom. Many average relationships persist in the contemporaneous network, indicating symptoms of cPTSD and psychosis co-occur, especially paranoia with hyperarousal and negative self-concept. The temporal network suggested that paranoia reciprocally predicted, and was predicted by, hyperarousal, negative self-concept, and emotional dysregulation from moment to moment. cPTSD did not directly relate to voices in the temporal network. Conclusions cPTSD and positive psychosis symptoms mutually maintain each other in trauma-exposed people with psychosis via the maintenance of current threat, consistent with cognitive models of PTSD. Current threat, therefore, represents a valuable treatment target in phased-based trauma-focused psychosis interventions.

Original language	English
Article number	e43
Number of pages	12
Journal	Psychological Medicine
Volume	55
DOIs	https://doi.org/10.1017/S0033291725000030
Publication status	Published - 20 Feb 2025

Bibliographical note

Publisher Copyright:
© The Author(s), 2025.

Keywords

disturbances of self-organization
experience sampling methodology
hallucinations
paranoia
trauma
visions

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A temporal network analysis of complex post-traumatic stress disorder and psychosis symptoms
© The Author(s), 2025
Final published version, 489 KBLicence: CC BY

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title = "A temporal network analysis of complex post-traumatic stress disorder and psychosis symptoms",

abstract = "Background Symptoms of complex post-traumatic stress disorder (cPTSD) may play a role in the maintenance of psychotic symptoms. Network analyses have shown interrelationships between post-traumatic sequelae and psychosis, but the temporal dynamics of these relationships in people with psychosis and a history of trauma remain unclear. We aimed to explore, using network analysis, the temporal order of relationships between symptoms of cPTSD (i.e. core PTSD and disturbances of self-organization [DSOs]) and psychosis in the flow of daily life. Methods Participants with psychosis and comorbid PTSD (N = 153) completed an experience-sampling study involving multiple daily assessments of psychosis (paranoia, voices, and visions), core PTSD (trauma-related intrusions, avoidance, hyperarousal), and DSOs (emotional dysregulation, interpersonal difficulties, negative self-concept) over six consecutive days. Multilevel vector autoregressive modeling was used to estimate three complementary networks representing different timescales. Results Our between-subjects network suggested that, on average over the testing period, most cPTSD symptoms related to at least one positive psychotic symptom. Many average relationships persist in the contemporaneous network, indicating symptoms of cPTSD and psychosis co-occur, especially paranoia with hyperarousal and negative self-concept. The temporal network suggested that paranoia reciprocally predicted, and was predicted by, hyperarousal, negative self-concept, and emotional dysregulation from moment to moment. cPTSD did not directly relate to voices in the temporal network. Conclusions cPTSD and positive psychosis symptoms mutually maintain each other in trauma-exposed people with psychosis via the maintenance of current threat, consistent with cognitive models of PTSD. Current threat, therefore, represents a valuable treatment target in phased-based trauma-focused psychosis interventions.",

keywords = "disturbances of self-organization, experience sampling methodology, hallucinations, paranoia, trauma, visions",

author = "Peter Panayi and Alba Contreras and Emmanuelle Peters and Richard Bentall and Amy Hardy and Katherine Berry and William Sellwood and Robert Dudley and Eleanor Longden and Raphael Underwood and Craig Steel and Hassan Jafari and Liam Mason and Filippo Varese",

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year = "2025",

month = feb,

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doi = "10.1017/S0033291725000030",

language = "English",

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journal = "Psychological Medicine",

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TY - JOUR

T1 - A temporal network analysis of complex post-traumatic stress disorder and psychosis symptoms

AU - Panayi, Peter

AU - Contreras, Alba

AU - Peters, Emmanuelle

AU - Bentall, Richard

AU - Hardy, Amy

AU - Berry, Katherine

AU - Sellwood, William

AU - Dudley, Robert

AU - Longden, Eleanor

AU - Underwood, Raphael

AU - Steel, Craig

AU - Jafari, Hassan

AU - Mason, Liam

AU - Varese, Filippo

PY - 2025/2/20

Y1 - 2025/2/20

N2 - Background Symptoms of complex post-traumatic stress disorder (cPTSD) may play a role in the maintenance of psychotic symptoms. Network analyses have shown interrelationships between post-traumatic sequelae and psychosis, but the temporal dynamics of these relationships in people with psychosis and a history of trauma remain unclear. We aimed to explore, using network analysis, the temporal order of relationships between symptoms of cPTSD (i.e. core PTSD and disturbances of self-organization [DSOs]) and psychosis in the flow of daily life. Methods Participants with psychosis and comorbid PTSD (N = 153) completed an experience-sampling study involving multiple daily assessments of psychosis (paranoia, voices, and visions), core PTSD (trauma-related intrusions, avoidance, hyperarousal), and DSOs (emotional dysregulation, interpersonal difficulties, negative self-concept) over six consecutive days. Multilevel vector autoregressive modeling was used to estimate three complementary networks representing different timescales. Results Our between-subjects network suggested that, on average over the testing period, most cPTSD symptoms related to at least one positive psychotic symptom. Many average relationships persist in the contemporaneous network, indicating symptoms of cPTSD and psychosis co-occur, especially paranoia with hyperarousal and negative self-concept. The temporal network suggested that paranoia reciprocally predicted, and was predicted by, hyperarousal, negative self-concept, and emotional dysregulation from moment to moment. cPTSD did not directly relate to voices in the temporal network. Conclusions cPTSD and positive psychosis symptoms mutually maintain each other in trauma-exposed people with psychosis via the maintenance of current threat, consistent with cognitive models of PTSD. Current threat, therefore, represents a valuable treatment target in phased-based trauma-focused psychosis interventions.

AB - Background Symptoms of complex post-traumatic stress disorder (cPTSD) may play a role in the maintenance of psychotic symptoms. Network analyses have shown interrelationships between post-traumatic sequelae and psychosis, but the temporal dynamics of these relationships in people with psychosis and a history of trauma remain unclear. We aimed to explore, using network analysis, the temporal order of relationships between symptoms of cPTSD (i.e. core PTSD and disturbances of self-organization [DSOs]) and psychosis in the flow of daily life. Methods Participants with psychosis and comorbid PTSD (N = 153) completed an experience-sampling study involving multiple daily assessments of psychosis (paranoia, voices, and visions), core PTSD (trauma-related intrusions, avoidance, hyperarousal), and DSOs (emotional dysregulation, interpersonal difficulties, negative self-concept) over six consecutive days. Multilevel vector autoregressive modeling was used to estimate three complementary networks representing different timescales. Results Our between-subjects network suggested that, on average over the testing period, most cPTSD symptoms related to at least one positive psychotic symptom. Many average relationships persist in the contemporaneous network, indicating symptoms of cPTSD and psychosis co-occur, especially paranoia with hyperarousal and negative self-concept. The temporal network suggested that paranoia reciprocally predicted, and was predicted by, hyperarousal, negative self-concept, and emotional dysregulation from moment to moment. cPTSD did not directly relate to voices in the temporal network. Conclusions cPTSD and positive psychosis symptoms mutually maintain each other in trauma-exposed people with psychosis via the maintenance of current threat, consistent with cognitive models of PTSD. Current threat, therefore, represents a valuable treatment target in phased-based trauma-focused psychosis interventions.

KW - disturbances of self-organization

KW - experience sampling methodology

KW - hallucinations

KW - paranoia

KW - trauma

KW - visions

UR - http://www.scopus.com/inward/record.url?scp=85218949506&partnerID=8YFLogxK

U2 - 10.1017/S0033291725000030

DO - 10.1017/S0033291725000030

M3 - Article

C2 - 39973045

AN - SCOPUS:85218949506

SN - 0033-2917

VL - 55

JO - Psychological Medicine

JF - Psychological Medicine

M1 - e43

ER -

A temporal network analysis of complex post-traumatic stress disorder and psychosis symptoms

Abstract

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Keywords

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