Fear of psychotic relapse: exploring dynamic relationships with common early warning signs of relapse using electronic once-a-day self-reports

Background: Fear of relapse into psychosis is an independent risk factor for future relapse events, indicating its importance as a novel intervention target. Methods: Twenty-five participants responded to daily ecological momentary assessment prompts assessing common early warning signs of relapse and self-reported positive experiences like feeling supported by others. We conducted multilevel vector auto-regression using common symptoms assessed in early warning signs monitoring relapse prevention while controlling for positive self-reported experiences like feeling supported by others to estimate three networks (to explore concurrent, temporal and overall relationships). Results: Reporting fear of relapse was positively associated (within the same cross-sectional time window) with hearing voices, alongside anxiety, negative affect and sleep change. Fear of relapse appeared to predict anxiety, negative affect and greater fear of relapse on the next consecutive day. However, none of the typical early warning signs predicted fear of relapse within the temporal window, and the observed relationships were small. Discussion: Early warning signs appeared to be poor predictors of experiencing fear of relapse in this study. Fear of relapse predicts later anxiety and negative affect and may be a valuable intervention target within the daily life of people diagnosed with schizophrenia.