The dynamics of social activation and suspiciousness in individuals at ultra-high risk for psychosis

Introduction: Social functioning is often impaired during the ultra-high risk (UHR) phase for psychosis, but grouplevel studies regarding the role of social functioning in transition to psychosis are inconsistent. Exploring the inter-individual differences which underlie the association between social functioning and psychotic symptoms in this phase could yield new insights. Objective: To examine the idiographic and dynamic association between social activation and suspiciousness in individuals at UHR for psychosis using time-series analysis. Methods: Twenty individuals at UHR for psychosis completed a diary application every evening for 90 days. Two items on social activation (quantity: 'time spent alone' and quality: 'feeling supported') and two items on suspiciousness ('feeling suspicious' and 'feeling disliked') were used. Time series (T = 90) of each individual were analyzed using vector auto regression analysis (VAR), to estimate the lagged (over 1 day) effect of social activation on suspiciousness, and vice versa, as well as their contemporaneous associations. Results: Heterogeneous person-specific associations between social activation and suspiciousness were found in terms of strength, direction and temporal aspects. Conclusions: The association between social activation and suspiciousness differs amongst individuals who are at UHR for psychosis. These findings underline the importance of tailoring psychosocial interventions to the individual. Future studies may examine whether using results of single-subject studies in clinical practice to personalize treatment goals leads to better treatment outcomes.