Concurrent Measurement of "Real-World" Stress and Arousal in Individuals With Psychosis: Assessing the Feasibility and Validity of a Novel Methodology

David Kimhy*, Philippe Delespaul, Hongshik Ahn, Shengnan Cai, Marina Shikhman, Jeffrey A. Lieberman, Dolores Malaspina, Richard P. Sloan

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: Psychosis has been repeatedly suggested to be affected by increases in stress and arousal. However, there is a dearth of evidence supporting the temporal link between stress, arousal, and psychosis during "real-world" functioning. This paucity of evidence may stem from limitations of current research methodologies. Our aim is to the test the feasibility and validity of a novel methodology designed to measure concurrent stress and arousal in individuals with psychosis during "real-world" daily functioning. Method: Twenty patients with psychosis completed a 36-hour ambulatory assessment of stress and arousal. We used experience sampling method with palm computers to assess stress (10 times per day, 10 AM -> 10 PM) along with concurrent ambulatory measurement of cardiac autonomic regulation using a Holter monitor. The clocks of the palm computer and Holter monitor were synchronized, allowing the temporal linking of the stress and arousal data. We used power spectral analysis to determine the parasympathetic contributions to autonomic regulation and sympathovagal balance during 5 minutes before and after each experience sample. Results: Patients completed 79% of the experience samples (75% with a valid concurrent arousal data). Momentary increases in stress had inverse correlation with concurrent parasympathetic activity ( = -.27, P <.0001) and positive correlation with sympathovagal balance ( = .19, P = .0008). Stress and heart rate were not significantly related ( = -.05, P = .3875). Conclusion: The findings support the feasibility and validity of our methodology in individuals with psychosis. The methodology offers a novel way to study in high time resolution the concurrent, "real-world" interactions between stress, arousal, and psychosis. The authors discuss the methodology's potential applications and future research directions.
Original languageEnglish
Pages (from-to)1131-1139
JournalSchizophrenia Bulletin
Issue number6
Publication statusPublished - Nov 2010


  • psychosis
  • schizophrenia
  • stress
  • arousal
  • heart rate variability
  • vagal
  • cardiac autonomic regulation
  • experience sampling method
  • palm computers


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