Publication Date



Open access

Embargo Period


Degree Type


Degree Name

Doctor of Philosophy (PHD)


Psychology (Arts and Sciences)

Date of Defense


First Committee Member

Amy Weisman de Mamani

Second Committee Member

Kiara Timpano

Third Committee Member

Patrice Saab

Fourth Committee Member

Michael Antoni

Fifth Committee Member

Blaine Fowers


Psychotic symptoms are distributed along a continuum, ranging from subclinical experiences to clinically-defined psychosis. Individuals who are on the clinically diagnosable end of the psychosis spectrum (e.g. schizophrenia) tend to have a heightened sensitivity to social stressors, like Expressed Emotion (EE). EE measures how critical or overly-involved a family member is towards an identified patient, and is positively associated with higher rates of relapse and greater symptomatic presentations following a patient’s hospitalization. Additionally, the mere exposure to a family member who is high in EE leads to greater physiological arousal in patients with schizophrenia compared to healthy controls. It is unclear, however, whether individuals not yet diagnosed, but at high-risk for a psychotic disorder, also have a heightened sensitivity to the social stress of EE. This study recruited individuals who are at high-risk for a psychotic disorder based on either genetic ties linking them to a first-degree family member (i.e. a parent or sibling) with schizophrenia and moderately elevated prodromal symptoms or elevated prodromal symptoms. The primary study aims were to examine whether high-risk individuals demonstrate greater physiological and subjective affective changes compared to low-risk controls after hearing critical, praise, and neutral comments directed at them. Measures of cardiovascular arousal (heart rate and heart rate variability), skin conductance, cortisol, affect and anxiety ratings were used to assess differential responses to EE in patients at high-risk for psychosis compared to low-risk controls. Data was analyzed using repeated measures ANOVAs on a total of 38 high-risk individuals and 38 low-risk controls. Contrary to hypotheses, high-risk individuals did not show differences in reactivity to critical comments compared to controls. However, following critical comments, high-risk individuals did have slower heart rate recovery to baseline compared to controls. Further, high-risk individuals showed significant responses to praise comments. Specifically, despite higher baseline levels of negative affect and heart rate, these levels became nearly indistinguishable to controls following praise. There was also some evidence, that high-risk individuals perceived neutral comments as more negative than did their low-risk control counterparts. Overall, these results suggest that high-risk individuals are not more reactive to criticism than controls. High-risk individuals do, however, start at higher levels of negative affect, anxiety and heart rate, and their heart rate is slower to recover than controls. Additionally, praise comments appeared to benefit high-risk individuals as the praise made them nearly indistinguishable from the control subjects on multiple indices. Study findings have important clinical implications. They suggest that attending to regulatory strategies for stressors (such as criticism) and increasing positive social interactions (such as praise) may be helpful in reducing physiological hyperactivity and affect symptoms.


affect; criticism; praise; heart rate; heart rate variability; cortisol