Discussion
psychotic symptoms, anxiety, psychosis
REGRESSION, PATHOLOGY, RECRUITMENT
Generally, measuring psychopathology vs. character strengths via questionnaires is not associated with changes in psychological states, including mood, optimism, therapy motivation, and perceived stigma. However, there were small-sized time effects that emerged in the form of decreased negative affect and perceived stigma, as well as improved cognitive performance (measured by the TMT), in comparison to baseline, for both the pathology focus and the character strengths focus. The reduced completion times for the TMT tasks may potentially be attributed to a learning effect. The reduction in negative affect and perceived stigma in both conditions could be interpreted as the result of the comprehensive assessment of symptoms and character strengths within the scope of this study, which may have led the participants to feel more perceived and less discriminated. In addition or alternatively, anticipatory anxiety or stress at the beginning of the study may have simply decreased over time (regression to the mean). As suggested by some studies, the phenomenon of initial elevation bias, whereby higher (especially negative) states are reported in initial assessments compared to later assessments, appears to be not uncommon in research utilizing subjective reports [Character strengths interventions seem to be well accepted and are viewed as important by individuals diagnosed with psychosis. Self-regulation descriptively is the least, kindness the most strongly endorsed strength in the current sample. Kindness was also among the most endorsed strengths in a sample with first episode psychosis, as were honesty and fairness [Addressing negative symptoms is highly important given the role for long-term functioning. This is supported by the aforementioned findings of Beck et al. [Limitations of the present study are, for one, the sampling approach. Some individuals reported a first episode (20.5%), most reported multiple episodes (69.2%), and some only past episodes (10.3%). The effects of the intervention could differ by the degree of chronification and this should be further investigated in future studies with larger samples, whereby moderation effects could be examined. Another point of criticism is the reliance on an online format and hence self-reported diagnoses, lacking a differentiated formal diagnosis (e.g., using the SCID-5). However, applying a lie scale, and descriptively comparing symptom scores of the CAPE in the current sample to other samples, suggested plausible expressions of psychotic symptoms in the present sample. As a matter of fact, the study was initially planned to be conducted face-to-face which would have allowed for a diagnostic assessment, but was then conducted online due to strict COVID-19 policies in Germany during the planned recruitment period. A face-to-face format could have furthermore elicited stronger effects of the manipulations, since a social component of the experimenter conducting the assessments and, perhaps, also giving feedback, could have had a much stronger impact upon the participants’ psychological states and performance. Another reason for the manipulation not being successful might have been that individuals could have self-criticized internally for lacking the strength at question, albeit the general improvement over time in negative affect, perceived stigma, and cognitive performance somewhat contradicts this notion. Instead of relying on longer blocks of assessment, and to separate the manipulation from the rest of the study, it would have been beneficial to work with feedback on strengths vs. feedback on deficits or pathology. In addition, it is possible that attempting a psychological state change induction twice and in opposite hypothesized directions during one experiment (within sample) may have been too ambitious–hence replication studies may use longitudinal or between-subject designs. Finally, the focus of the study was on the effect of assessing strengths vs. deficits, and not the effect of character strength feedback per se. However, evaluating the effect of the strength feedback on psychological states might have been insightful beyond the assessment of overall perceived relevance of the topic and subjective benefit, and this should be implemented in future studies. The reported reliabilities of the scales, which refer to the sample of this study, were generally good (α >.80), however three of the VIA-IS scales for the character strengths showed unsatisfactory reliability of a Cronbach’s α < .60 (i.e., We conclude that positive psychology character strengths interventions are well accepted and perceived as relevant in a mixed sample of individuals with psychosis. Future studies should focus on the effects of strengths vs. deficit assessment and feedback, and use longitudinal, or between-subject approaches to study supposed changes in psychological states. Further research on the topic of character strengths interventions in psychosis seems worthwhile especially from the theoretical background of negative self-appraisal and defeatist beliefs being commonly related to negative symptoms and cognitive performance in psychosis, which play a major role in the quality of life and long-term functioning of affected individuals.