ORIGINAL RESEARCH published: 15 March 2021 doi: 10.3389/fpsyt.2021.623755 Self-Schemas and Self-Esteem Discrepancies in Subclinical Paranoia: The Essential Role of Depressive Symptoms Manel Monsonet 1 , Sergi Ballespí 1 , Tamara Sheinbaum 2 , Carmen Valiente 3 , Regina Espinosa 4 , Thomas Richard Kwapil 5 and Neus Barrantes-Vidal 1,6,7* 1 Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain, 2 Department of Psychology, University of Southern California, Los Angeles, CA, United States, 3 School of Psychology, Complutense University of Madrid, Pozuelo de Alarcón, Spain, 4 Department of Psychology, University of Camilo José Cela, Villanueva de la Cañada, Spain, 5 Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, United States, 6 Sant Pere Claver - Fundació Sanitària, Barcelona, Spain, 7 Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain Background : Self-concepts are being intensively investigated in relation to paranoia, but research has shown some contradictory findings. Studying subclinical phenomena in a non-clinical population should allow for a clearer understanding given that clinical confounding factors are avoided. We explored self-esteem, self-schemas, and Edited by: Henry W. Chase, implicit/explicit self-esteem discrepancies in three non-clinical groups with different University of Pittsburgh, United States psychopathological traits and a control group. Reviewed by: Methods: Participants with elevated trait-paranoia (n = 41), depressive symptoms Lyn Ellett, University of London, United Kingdom (n = 34), a combination of both traits (n = 32), and a control group (n = 71) were Robert Christian Wolf, assessed on implicit and explicit self-esteem, self-schemas, depression, and paranoia. Heidelberg University, Germany A dimensional approach with the total sample (n = 208) was also used to complement *Correspondence: Neus Barrantes-Vidal the information provided by the group approach. neus.barrantes@uab.cat Results: All groups presented similar and positive levels of implicit self-esteem. Trait-paranoia participants had similar levels of explicit self-esteem and self-schemas Specialty section: This article was submitted to compared with the control group. However, the group with a combination of Psychopathology, trait-paranoia and depressive symptoms showed the lowest levels of positive a section of the journal Frontiers in Psychiatry self-schemas and self-esteem. Furthermore, this group and the control group displayed Received: 30 October 2020 implicit/explicit self-esteem discrepancies, although in opposite directions and with Accepted: 02 February 2021 different implications. The dimensional approach revealed associations of trait-paranoia Published: 15 March 2021 and depressive symptoms with poor explicit self-esteem and self-schemas but not with Citation: implicit self-esteem. Monsonet M, Ballespí S, Sheinbaum T, Valiente C, Espinosa R, Conclusions: Trait-paranoia participants showed different self-representations Kwapil TR and Barrantes-Vidal N depending on whether depressive symptoms were present or not. The (2021) Self-Schemas and Self-Esteem Discrepancies in Subclinical Paranoia: interaction between subclinical neurotic and psychotic traits entailed a detrimental The Essential Role of Depressive self-representation that might increase the risk for psychopathology. Symptoms. Front. Psychiatry 12:623755. Keywords: paranoia, self-esteem, self-schemas, depressive symptoms, self-esteem discrepancies, implicit doi: 10.3389/fpsyt.2021.623755 self-esteem Frontiers in Psychiatry | www.frontiersin.org 1 March 2021 | Volume 12 | Article 623755 Monsonet et al. Self-Schemas and Self-Esteem Discrepancies in Subclinical Paranoia INTRODUCTION study assessed implicit SE using three different paradigms and found positive implicit SE for depressed participants in Understanding psychopathological phenomena as a dimensional the three measures (32). Indeed, it has been demonstrated continuum, which range from mental health to severe mental that high implicit SE is not necessarily advantageous for illness, have a long tradition (1–5). Psychosis is currently psychological health, and that discrepancies between explicit SE conceptualized as a dynamic continuum that ranges from and implicit SE could be more damaging than high or low SE individual differences in schizotypy traits and subtle psychotic- per se (36). like experiences through at-risk mental states (ARMS) or The study of discrepancies between explicit SE and implicit prodromal states to schizophrenia-spectrum disorders (6–8). SE seems critical and intimately connected with paranoia, but the Likewise, depression can be conceived as a dynamic continuum evidence is scarce (37). Discrepancies between explicit SE and that extends from non-clinical experiences or feelings of implicit SE can occur in two different ways: higher explicit SE depression to severe depressive disorders (9–11). Studying than implicit SE or higher implicit SE than explicit SE (36, 38), subclinical phenomena in non-clinical populations complements and it has been found that SE discrepancies in either direction the information obtained from ill participants and provides a could be damaging for psychological health (36, 37). As Bentall “cleaner” laboratory to grasp subtle psychological constructs by and colleagues proposed (29), measuring discrepancies between avoiding confusion factors such as elevated symptom severity, implicit SE and explicit SE might be especially relevant for high comorbidity, medication side-effects, and the chronicity testing the defensive model of paranoia. It could be expected that of the disorder itself, thus allowing to elucidate mechanisms of paranoid patients would have lower implicit SE than explicit SE. disorder risk, resilience, and onset (12). In addition, comparing levels of implicit SE between patients with Two psychological constructs that have attracted considerable persecutory delusions and patients without paranoia or healthy attention are self-esteem (SE) and self-schemas (SC), which are controls should provide meaningful evidence for a defensive widely involved not only in depression but also in psychosis, model. To date, research has yielded contradictory results in and more specifically, in paranoia (13, 14). Low SE is one of the clinical populations, with some studies supporting or partially diagnostic criteria for a DSM-5 diagnosis of major depressive supporting the defensive model (39–41), and others not (42– disorder (15). However, it has also been demonstrated that 45). However, two of the three studies that assessed discrepancies neuroticism and low SE are risk factors for psychosis (16, 17). directly comparing z-scores of implicit SE and explicit SE within Besides, it is well-known that there is a high association between groups of paranoid and depressed patients, and healthy controls depression, low SE, negative SC, and persecutory delusions (18, reported no SE discrepancies in paranoid patients. Curiously, 19), and it has even been suggested that some forms of paranoid though, Kesting and colleagues (42) found differences between schizophrenia might be camouflaged depression (20). Depression levels of explicit SE and implicit SE in healthy controls and is also associated with severity, distress, prognosis, and relapse of depressed patients but not in acute and remitted deluded psychotic symptoms (21), and it is estimated that comorbidity patients. Vázquez et al. (45) found similar results using identical with schizophrenia occurs in 50% of patients (22). It has also groups but a different measure of implicit SE. In both studies, been shown that negative SC (in combination with anxiety and the depressed group showed the same pattern of discrepancy: negative-other self-evaluations), but not positive SC or low SE, higher implicit SE than explicit SE. Conversely, higher explicit were associated with non-clinical paranoia (23). However, other SE than implicit SE was found in the healthy control group. studies have found that low positive SC (24, 25) and low SE (26– Thus, it remains unclear whether differences between explicit 28) correlated with paranoia in non-clinical populations. Thus, SE and implicit SE characterize clinical and subclinical paranoid the precise pattern of associations between SC, SE, and paranoia samples. To the best of our knowledge, no studies have tested in non-clinical populations remains unclear. SE discrepancies in non-clinical paranoia by directly comparing Regarding persecutory delusions, Bentall et al. (29) proposed z-scores of implicit SE and explicit SE. Therefore, the present a model based on a cycle of mutual influences between study was the first to examine SE discrepancies in subclinical causal attributions and self-representations. They argued that paranoia. Moreover, it is the first time that levels of explicit SE in order to maintain deactivated implicit negative beliefs and implicit SE, as well as SC, were compared among three non- about the self, people with persecutory delusions attribute clinical groups with elevations in different psychopathological negative events to external agents. Although this “defensive traits: paranoia, depression, and a combination of the two. model” did not intend to make any prediction about the The first goal of the present study was to examine levels and role of explicit SE, some studies have ruled it out because differential patterns of implicit SE and explicit SE, as well as low levels of explicit SE in paranoid patients have been SC, in non-clinical subjects with elevated levels of trait-paranoia documented. This defensive model only assumed, and showed with and without elevated levels of depressive symptoms, non- evidence from implicit measures, that paranoid patients, clinical subjects with high levels of depressive symptoms, and like depressed people, have latent negative beliefs about the a control group. Secondly, discrepancies between z-scores of self. Nevertheless, recent findings are inconsistent with this implicit SE and explicit SE were also explored within these four assumption regarding paranoia, showing mixed results [see groups. Finally, a dimensional approach using the total sample reviews: (18, 30, 31)]. In contrast, there is mounting evidence (n = 208) was employed to explore whether trait-paranoia, indicating that depressed patients show positive implicit SE, depressive symptoms, and their interaction predicted SE, SC, actually similar to that of healthy controls (32–35). One positive discrepant SE (i.e., higher implicit SE than explicit Frontiers in Psychiatry | www.frontiersin.org 2 March 2021 | Volume 12 | Article 623755 Monsonet et al. Self-Schemas and Self-Esteem Discrepancies in Subclinical Paranoia SE), and negative discrepant SE (i.e., higher explicit SE than The Control group (ConG) included those 71 participants implicit SE). of the total sample who scored below the percentile 50 on Firstly, and according to Bentall et al. (29), it was hypothesized both measures. that trait-paranoia would be associated with negative implicit SE, whereas in line with recent research, depressive symptoms would be related to positive implicit SE. It was also predicted Materials and Procedure that subclinical paranoia and depression would be associated The interviews were conducted by psychologists and advanced with low levels of explicit SE and SC. Specifically, we expected graduate students in clinical psychology who were trained to find lower levels of explicit SE and SC in groups with in the administration of the measures and were unaware of elevated levels of depressive symptoms. Secondly, regarding the participants’ scores on the screening questionnaires. The study discrepancies between z-scores of explicit SE and implicit SE was approved by the Universitat Autònoma de Barcelona (Spain) within groups, no discrepancies were expected in the trait- Ethics Committee and conformed to the Helsinki Declaration. paranoia group. However, positive discrepant SE was predicted for the groups with depressive symptoms, while negative discrepant SE was expected for the control group. Finally, when Implicit SE using dimensional scores in the total sample, we hypothesized The Go/No-Go Association Task (GNAT) (50) was employed that trait-paranoia and depressive symptoms would be associated to assess implicit SE. The GNAT is conceptually based on with explicit SE and SC, although a larger association with the Implicit Association Test (IAT) (51), but it does not need depressive symptoms was expected. We also predicted that the direct involvement of an opposed target category to make trait-paranoia would not be related to any form of discrepant inferences (50, 52). Therefore, the GNAT has the advantage of SE, whereas depressive symptoms would be related to positive analyzing automatic responses between the attribute concepts discrepant SE. (e.g., positive, negative) and a single target category (e.g., the self). Williams and Kaufman (53) have demonstrated its reliability and some studies have shown its convergent, discriminant, and METHODS predictive validity (54, 55). The GNAT self-esteem version used in this study was Participants presented using Inquisit (Millisecond Software, 1996–2007). It The present study is part of an ongoing longitudinal project comprised 28 words (of which 14 were positive and 14 negative) examining risk and resilience for psychosis (BLISS) (46). At and assessed the strength of the automatic associations between time one, an unselected sample of 589 undergraduates at words related to the concept of “Self ” (e.g., myself, I, participant’s the Universitat Autònoma de Barcelona was screened for first name) and positive attributes (e.g., smart, competent) and schizotypy traits. Usable screening data was obtained from negative attributes (e.g., unable, stupid) (41). The 28 stimulus 547 participants (42 were excluded due to invalid protocols). words were validated in a study of positive and negative adjectives At time two, a smaller sample was selected for intensive related to self-worth (56). The GNAT had two critical blocks assessment and participants with high schizotypy scores were (self-positive and self-negative) randomly presented; each block oversampled in order to ensure an adequate representation contains the first 20 practice trials and then 60 critical trials. For of schizotypy variance. A detailed description of the sample each trial, one word appears in the middle of the screen while selection procedure has been provided elsewhere (46, 47). A total informative labels for the correct response are fixed in the upper of 208 (out of 214) participants, which successfully completed left and right corners. Participants had to press the space bar the implicit self-esteem assessment as well as other measures only if the word that appears in the middle of the screen (e.g., described above, were included in this study. The mean age of smart) belongs to one of the two informative labels (e.g., self, this sample was 19.7 years (SD = 2.3) and 77.9% were women. positive). If the word did not match the informative labels (e.g., Four different groups were also yielded: unable), participants did not have to respond. Words appear for The Depression group (DepG) included those 34 participants a maximum of up to 1,200 ms or until the participant presses of the total sample (n = 206) who scored in the top quartile of the space bar. Participants are instructed to respond as fast and the Beck Depression Inventory-II (BDI-II) (48) and had trait- accurately as possible and they had immediate feedback in each paranoia levels below the top quartile (percentile 73) as measured trail: A green O followed a correct response while a red X followed by the Suspiciousness subscale (SPQ-S) of the Schizotypal an incorrect response. Personality Questionnaire (SPQ) (49). To calculate the implicit SE score, reaction times in the The Paranoia group (ParG) included those 41 participants of positive-self blocks were subtracted from reaction times in the the total sample who scored in the top quartile of the SPQ-S negative-self blocks. A positive score means that the participant and had levels of depressive symptoms below the top quartile as is faster associating the self with positive adjectives than the self measured by the BDI-II. with negative adjectives. This would be interpreted as positive The Mixed group (MixG) included those 32 participants of implicit SE, whereas a negative score suggests negative implicit the total sample who scored in the top quartile on both trait- SE. Although other indices (e.g., d’) can be computed, reaction paranoia and depressive symptom measures (SPQ-S and BDI- time indices have shown higher internal consistency (41) and II, respectively). much more internal reliability (50). Frontiers in Psychiatry | www.frontiersin.org 3 March 2021 | Volume 12 | Article 623755 Monsonet et al. Self-Schemas and Self-Esteem Discrepancies in Subclinical Paranoia Explicit SE or Tamhane tests were employed depending on the assumption To assess global explicit SE, a Spanish version (57) of the of homogeneity of variances between groups. A mixed-model Rosenberg self-esteem scale (RSE) (58) was used. The RSE ANOVA with two within-subject variables (implicit SE and consists of five positively worded items and five negatively explicit SE) and one between-subject variable with four groups worded items (e.g., “I take a positive attitude toward myself ”) (DepG, ParG, MixG, and ConG) was conducted to test measured on a four-point scale. Scores range from 0 to 30, where discrepancies between z-cores of implicit SE and explicit SE. higher scores reflect higher explicit SE. Bonferroni correction for multiple comparisons was employed. Effects sizes were interpreted following Cohen (59): η2 = 0.01 as Discrepant SE small, η2 = 0.06 as medium, and η2 = 0.14 as large. The strategy Following previous studies [e.g., (36, 37)], we created an index of comparing groups with “pure” trait-paranoia, depression, and of discrepant SE. For each participant, standardized values of mixed profiles allows for a comparison with clinical samples explicit SE were subtracted from standardized values of implicit with depression and paranoia. At the same time, the continuous SE. Then, in order to test whether trait-paranoia, depressive nature of measures and the non-clinical nature of the sample symptoms, and their interaction predicted a combination of allowed for a complementary dimensional approach. Thus, a higher levels of implicit SE than explicit SE (positive discrepant series of hierarchical linear regression were performed to explore SE), or on the contrary, a combination of higher levels of explicit the linear effect of paranoid traits, depressive symptoms, and SE than implicit SE (negative discrepant SE), two continuous their interaction term on the frequency of implicit SE, explicit SE, variables of discrepant SE were calculated. Positive discrepant and discrepant SE and SC. Paranoia and depression scores were SE variable included those participants with positive scores entered simultaneously at the first step to evaluate their unique on discrepant SE (higher levels of implicit SE than explicit contribution, and then the interaction term was entered at the SE), whereas negative discrepant SE variable included those second step to evaluate its effect beyond the main effects. participants with negative scores on discrepant SE (higher levels of explicit SE than implicit SE). A score of 0 on discrepant SE (no differences between levels of implicit SE and explicit SE) RESULTS indicated congruent SE. No sex differences were found for implicit SE (t = 0.996, p = Self-Schemas 0.312), explicit SE (t = 0.132, p = 0.895), negative SC (t = The Brief Core Schema Scales (BCSS) is a self-reported measure −0.544, p = 0.587), positive SC (t = 0.694, p = 0.488), positive that assesses beliefs about the self and others (23), which yields discrepant SE (t = 0.238, p = 0.813), negative discrepant SE subscale scores for positive-self, negative-self, positive-others, (t = −0.169, p = 0.866), SPQ-S (t = −0.027, p = 0.978), and and negative-others. For the purpose of this study, only positive- BDI-II (t = −0.141, p = 0.888) in the overall sample. Only self and negative-self subscales were used. Each subscale contains a weak association between age and positive SC (r = −0.183, six items rated on a five-point scale, ranging from 0 to 4, where p = 0.008) was found. Regarding the GNAT, the means of the lower scores mean low positive or negative SC, respectively. reaction times on the positive-self and negative-self blocks were Schizotypal Personality Questionnaire 534.34 ms (range: 371.63–727.69) and 561.16 ms (range: 407.18– The SPQ (49) is a self-reported scale to evaluate DSM-III-R 769.42), respectively, for the whole sample. Therefore, the mean schizotypal personality disorder. It consists of 70 dichotomous of the implicit SE score was 26.82 ms (range: −137.80–136.67) for yes-no questions and yields nine subscales, one for each DSM the whole sample. There were no significant differences among schizotypal trait. The eight-item SPQ-S was used to measure groups on age (F [3, 174] = 0.980, p = 0.404) or sex (χ 2 = 2.396, p trait-paranoia in this sample (e.g.: “I am sure I am being talked = 0.494). Descriptive data on paranoia and depression measures about behind my back”). for all groups are presented in Table 1. As expected, the ParG and the MixG groups had higher levels of paranoia than the Beck Depression Inventory-II DepG and the ConG (F [3, 174] = 235.65, η2 = 0.80, p < 0.001). The BDI-II (48) was used to dimensionally measure depressive Similarly, the depression and the mixed groups had higher levels symptoms. It contains 21 items that are rated on a four- of depressive symptoms than the paranoia and the control groups point scale ranging from 0 to 3. Total score ranges between (F [3, 174] = 129.91, η2 = 0.69, p < 0.001). 0 and 63, where higher scores indicate greater severity of Firstly, the results of ANOVAs comparing implicit SE and depressive symptoms. explicit SE, discrepant SE, as well as SC across groups are presented in Table 2. No significant differences were found Statistical Analyses among groups for implicit SE (F [3, 174] , η2 < 0.01); all groups All analyses were conducted using the Statistical Package for displayed positive implicit SE. Conversely, there was a large Social Sciences (SPSS), Version 19.0. Potential sex differences group effect for explicit SE (F [3,171] , η2 = 0.37). Post hoc tests were tested with the Student’s t test. To test for differences indicated that the MixG had lower levels of explicit SE than the in sex and age among groups, a chi-square test and one- other groups (ConG and ParG: p < 0.001; DepG: p = 0.033), way ANOVA were respectively performed. Analyses of variance whereas the DepG showed lower levels than the ParG (p = 0.011) were used to compare groups on implicit SE, explicit SE, and and the ConG (p < 0.001). Thus, the paranoia and control groups discrepant SE and SC. To compare means, post hoc Tukey HSD had similar levels of explicit SE (p = 0.306). There was also a large Frontiers in Psychiatry | www.frontiersin.org 4 March 2021 | Volume 12 | Article 623755 Monsonet et al. Self-Schemas and Self-Esteem Discrepancies in Subclinical Paranoia TABLE 1 | Means (standard deviations) and score ranges on paranoia and associated with implicit SE or with any type of discrepant SE. depression measures for groups. Depressive symptoms were negatively associated with explicit BDI-II SPQ-S SE and positive SC but positively associated with negative SC and positive and negative discrepant SE. Conversely, depressive Control group 1.34 (1.16); range: 0–3 1.14 (0.76); range: 0–2 symptoms did not predict implicit SE. Lastly, the interaction term Depression group 11.56 (5.17); range: 7–29 2.26 (1.26); range: 0–3 between trait-paranoia and depressive symptoms predicted levels Paranoia group 3.24 (2.05); range: 0–6 4.90 (1.01); range: 4–8 of explicit SE beyond the main effects (and a trend was observed Mixed group 11.59 (4.35); range: 7–25 5.88 (1.04); range: 5–8 for negative SC; p = 0.057). No more significant associations were found. BDI-II, The Beck Depression Inventory-II; SPQ-S, The Suspiciousness subscale of the Schizotypal Personality Questionnaire (SPQ). DISCUSSION group effect for negative SC (F [3, 174] , η2 = 0.17), with the MixG showing higher negative SC than the ParG and ConG (all p- The present study compared three non-clinical groups with values < 0.005). Positive SC was also significantly different across paranoia, depression symptoms, and a combination of the two groups (F [3, 174] , η2 = 0.08). The MixG had a lower positive SC features, in addition to a control group, to shed light on the than the ConG (p = 0.002). Thus, the depression, paranoia, and association of these constructs with implicit SE, explicit SE, control groups showed no significant differences for positive and and discrepant SE and SC. In line with our hypotheses, we negative SC. There was a large group effect for positive discrepant found no discrepancies between explicit SE and implicit SE SE (F [3,74] , η2 = 0.15), indicating that the MixG had a higher in the trait-paranoia group; although explicit SE was slightly positive discrepancy than the ConG. A medium group effect for higher than implicit SE, both measures were positive and did negative discrepant SE (F [3,93] , η2 = 0.09) was also found, with not significantly differ. Likewise, dimensional analyses revealed the ParG showing a higher negative discrepancy than the MixG. that neither trait-paranoia nor the interaction between trait- No other differences were found among groups. paranoia and depressive symptoms were associated with implicit Secondly, the analysis of differences between z-cores of SE, thus replicating and expanding the results found by Cicero implicit SE and explicit SE revealed that the main effect was not and Kerns (26) who found that implicit SE was unassociated with significant (F = 1.61, p = 0.207, η2 = 0.00), whereas a significant paranoia in non-clinical participants using a different measure of effect for group was found (F = 17.93, p < 0.001, η2 = 0.24). The implicit SE. Finally, positive and similar levels of implicit SE were ConG had a higher overall SE than the DepG and the MixG, while found across all groups. Therefore, these findings do not support the ParG showed higher SE than the MixG (all p-values< 0.001). Bentall’s defensive model in a non-clinical population with A significant two-way interaction between SE and group was trait-paranoia, regardless of whether depressive symptoms were also obtained (F = 10.64, p < 0.001, η2 = 0.16). Within-group present or not. It is likely that some phenomena in the psychotic pairwise comparisons revealed a discrepancy between explicit SE spectrum may differ in their expression depending on the severity and implicit SE in the ConG (p < 0.001, η2 = 0.06) and the of the associated impairment. Thus, it could be argued that while MixG (p < 0.001, η2 = 0.09). The ConG had higher explicit subclinical paranoid experiences do not reach the severity of SE than implicit SE, whereas the opposite pattern was found persecutory delusions implicit SE would remain preserved and in the MG. The depression and paranoia groups did not show psychotic defenses would not be triggered. However, two of three a statistically significant discrepancy (p = 0.138, η2 = 0.01; studies with paranoid patients that directly compared z-cores of p = 0.182, η2 = 0.01; respectively). Between-group pairwise implicit SE and explicit SE (42, 45) also found no discrepancies comparisons for explicit SE and implicit SE revealed similar in the paranoid group. Furthermore, the fact that these studies, results to those described above with one-way ANOVA analyses. and the present study, employed different paradigms to assess Means of implicit SE and explicit SE z-scores for all groups are implicit SE seems to strengthen the hypothesis that paranoia depicted in Figure 1. is not associated with SE discrepancies or low implicit SE. Finally, the results of the regression models conducted with Alternatively, it has been suggested that SE discrepancies would the total sample (i.e., dimensional approach) are presented in differ depending on the person’s belief about the deservedness of Table 3. Of the total sample (n = 208), three participants had the persecutory delusion. Whereas, “bad-me” paranoia patients RSE invalid data; therefore, for explicit SE and discrepant SE believe that the persecution is deserved, basically because the self variables, the total sample was 205 participants. Of these, 96 is viewed as bad, “poor-me” paranoia patients believe that the had positive discrepant SE (higher levels of implicit SE than persecution is not deserved (60). Nakamura and collaborators explicit SE), 108 had negative discrepant SE (higher levels (40) found that poor-me paranoia patients, but not Bad-me, of explicit SE than implicit SE), and one participant had showed a SE discrepancy. However, this finding should be congruent SE (no differences among implicit SE and explicit SE). interpreted with caution given the small sample size recruited For each predictor (trait-paranoia, depressive symptoms, and of the poor-me paranoia group (n = 14) and the fact that when their interaction), the standardized regression coefficients (β), both paranoid groups were jointly assessed (n = 35), no SE semipartial r2 , and effect sizes f 2 are reported. Trait-paranoia discrepancy was found. Actually, it has been claimed that the predicted explicit SE and negative SC, while a trend was observed concept of deservedness in paranoia is not a specific categorical for positive SC (p = 0.059). In contrast, trait-paranoia was not distinction (61), but rather a dimensional facet of paranoia (62). Frontiers in Psychiatry | www.frontiersin.org 5 March 2021 | Volume 12 | Article 623755 Monsonet et al. Self-Schemas and Self-Esteem Discrepancies in Subclinical Paranoia TABLE 2 | Mean differences (and standard deviations) in self-esteem and self-schema variables among groups. Groups CG DG PG MG ANOVA overall p (n = 71) (n = 34) (n = 41) (n = 32) Implicit SE 25.81 (42.54) 22.03 (37.68) 23.90 (54.74) 19.89 (49.08) F = 0.14 0.937 Explicit SE 25.50 (2.94) 21.03 (4.16) 24.18 (4.07) 17.78 (4.92) F = 33.37 <0.001 Summary of post hoc tests: CG, DG, PG > MG; CG, PA > DG Negative SC 1.65 (1.94) 3.50 (4.16) 2.34 (2.09) 5.03 (3.60) F = 11.46 <0.001 Summary of post hoc tests: MG > CG, PG Positive SC 13.72 (4.78) 11.85 (3.93) 12.76 (4.87) 10.06 (4.37) F = 4.97 0.002 Summary of post hoc tests: MG < CG Positive (n = 19) (n = 19) (n = 18) (n = 22) discrepant SE* 0.77 (0.47) 1.28 (0.81) 1.17 (0.90) 1.76 (1.20) F = 4.19 0.009 Summary of post hoc tests: MG > CG Negative (n = 50) (n = 14) (n = 22) (n = 10) discrepant SE* −1.02 (0.68) −0.91 (1.01) −1.47 (0.95) −0.69 (0.81) F = 3.06 0.033 Summary of post hoc tests: PG > MG CG, control group; DG, depression group; PG, paranoia group; MG, mixed group; ANOVA, analysis of variance; SE, self-esteem; SC, self-schemas. *n indicates the number of participants within each group assigned to positive or negative SE discrepancy. FIGURE 1 | Means of explicit and implicit self-esteem z-scores in the control (CG), depressive (DG), paranoia (PG), and mixed (MG) groups. As expected, the control group presented a statistically hazards (63). Kesting et al. (42) speculated that representing significant discrepancy, with higher levels of explicit than implicit oneself explicitly in a more positive way than oneself implicitly SE. Nevertheless, both measures of SE were positive, reflecting feels might be protective. Then, this pattern of self-representation optimal levels of implicit SE and explicit SE. Thus, it could be would be adaptive or normative to healthy people reflecting inferred that the control group had secure SE, as there is no need normal cognitive processes. However, it might also simply to adopt defensive strategies to protect the self from eventual reflect a social desirability bias when responding to personality Frontiers in Psychiatry | www.frontiersin.org 6 March 2021 | Volume 12 | Article 623755 Monsonet et al. Self-Schemas and Self-Esteem Discrepancies in Subclinical Paranoia TABLE 3 | Linear regressions of self-esteem and self-schemas measures (n = 208). Step 1 (df = 205) Step 2 (df = 204) Criterion Trait-paranoia Depressive symptoms Interaction β 1r 2 f2 β 1r 2 f2 β 1r 2 f2 Negative SC 0.191** 0.095 0.04 0.312*** 0.147 0.10 0.125† 0.055 0.02 Positive SC −0.137† 0.045 0.02 −0.204** 0.065 0.04 −0.050 0.016 0.00 Implicit SE −0.025 0.001 0.00 −0.020 0.001 0.00 −0.037 0.002 0.00 n = 205 Step 1 (df = 202) Step 2 (df = 201) Explicit SE −0.142* 0.130 0.03 −0.574*** 0.394 0.48 −0.112* 0.080 0.02 Positive discrepant SE 0.144 0.066 0.02 0.356** 0.162 0.14 0.131 0.086 0.02 Negative discrepant SE −0.164 0.006 0.02 0.226* 0.027 0.05 0.058 0.009 0.00 † p < 0.06; *p < 0.05; **p < 0.01; ***p < 0.001. SE, self-esteem; SC, self-schemas. or attitudinal questionnaires (64). In contrast, the group with Furthermore, one study with a large sample size also found no depressive symptoms showed higher implicit SE than explicit SE; differences in explicit SE between high and low non-clinical however, this difference was not statistically significant, contrary paranoid participants (27). It might be that low levels of to what was found in clinical samples (42, 45). Probably, the explicit SE in paranoia were mainly dependent on the neurotic fact that our participants did not have clinical depression and, processes that, as many studies pointed out [e.g., (69, 70)], therefore, their levels of explicit SE remained relatively preserved are frequently involved in the formation and maintenance of may explain the differences in SE discrepancies found among psychotic delusions. clinical and non-clinical samples with depressive symptoms. A slightly different picture appears concerning positive and Nevertheless, in line with other studies (32, 34, 35, 65) and in negative SC. The depression and paranoia groups had slightly accordance with our hypothesis, the depression group showed low levels of positive SC and high levels of negative SC than the positive or normal levels of implicit SE. Finally, the mixed group control group; however, this difference did not reach statistical did have a significant positive discrepancy (as expected for the significance. Thus, contrary to our expectations, the depression depression group), showing low explicit SE and positive implicit and paranoia groups showed similar levels of SC to the control SE. Thus, the mixed group was the only group that presented group. This seems to indicate that as long as paranoia traits and insecure SE (36), specifically, damaged SE (66). However, this depressive symptoms do not exceed the clinical threshold, SC will pattern of unbalanced self-representation where implicit SE remain relatively preserved. Our results are in agreement with was normal or positive and explicit SE was low does not Taylor et al. (71), who found very similar levels of SC in non- match with the pattern of discrepancy predicted by Bentall and clinical participants who endorsed some schizotypy experiences, colleagues in paranoia patients (29). In sum, our participants and with Espinosa and colleagues (72), who reported similar with a combination of depressive symptoms and trait-paranoia levels of negative beliefs about the self between depressed and showed a similar pattern to that of clinically depressed patients paranoid patients. Conversely, levels of positive and negative (33, 41, 42, 45) and indicate different self-representations in SC in the group with a combination of trait-paranoia and trait-paranoia individuals depending on whether depressive depressive symptoms were lower than in the control group symptoms were present or not. This emphasizes the relevance and comparable with those found in individuals at clinical of taking into account the interaction between depressive and high risk of developing psychosis (71, 73, 74). Therefore, once paranoid symptoms and suggests that this interaction should again, the mixed group displayed an unfavorable conscious self- be considered regarding the etiology and prognosis of paranoid representation that seems relevant for both the negative and the ideation. Notably, patients with schizophrenia who had suffered positive dimensions of SC. depression at the prodromal stage exhibited more severe first Finally, whereas the dimensional approach with the total psychotic episodes and more depressive and positive symptoms sample revealed significant associations of trait-paranoia with over the initial 5-year course (67). explicit SE and negative SC (only a trend was present for Regarding explicit SE, our hypotheses were partially positive SC), depressive symptoms were related to explicit SE, supported, as the depression and mixed groups showed the positive and negative SC, and SE discrepancies. The fact that lowest levels. In contrast, the paranoia group had similar in the dimensional approach, where the whole sample was levels of explicit SE to the control group. Although recent examined, trait-paranoia was not associated with any type of reviews (18, 31) indicated an association of low explicit SE with discrepant SE is in line with the finding that the paranoia group paranoia in patients and non-clinical populations, some studies did not show a discrepancy between explicit SE and implicit did not control for depressive symptoms while others found SE. Instead, depressive symptoms in the total sample were positive or normal levels of SE in paranoid patients (41, 60, 68). related to both positive and negative discrepant SE, although the Frontiers in Psychiatry | www.frontiersin.org 7 March 2021 | Volume 12 | Article 623755 Monsonet et al. Self-Schemas and Self-Esteem Discrepancies in Subclinical Paranoia association of depressive symptoms with the positive discrepancy The present study showed that levels of positive and negative was larger, which is in line with findings in clinical depression SC, explicit SE, and SE discrepancies in subclinical paranoia (33, 42, 45). Participants with negative discrepant SE would be depend on the presence and levels of depressive symptoms. more susceptible to have fluctuating SE discrepancies because In contrast, positive and similar levels of implicit SE were having low implicit SE and high explicit SE is associated with found in subclinical paranoia regardless of the presence of an unstable explicit SE (75), which can partly explain the depressive symptoms. In line with recent research, our findings association of depressive symptoms with negative discrepant indicate that paranoia was related to negative explicit SE, but SE. It is also noteworthy that the interaction term negatively no association was found between paranoia and implicit SE predicted explicit SE beyond the main effects of trait-paranoia (30, 43). Thus, individuals with subclinical paranoia would and depressive symptom, and was very close to statistical present different self-representations depending on whether significance in negative SC. This seems to confirm, also in the depressive symptoms were present or not. The combination of total sample, that the interaction between trait-paranoia and trait-paranoia and depressive symptoms yielded an unfavorable depressive symptoms aggravates the negative self-concept of conscious self-concept, suggesting that the interaction between individuals, which might increase the risk for psychopathology. subclinical neurotic and psychotic traits entailed a detrimental The association of depressive symptoms with explicit SE was self-representation that could entail an increased risk for the of a large magnitude, and very close to a medium with development of psychopathology. positive discrepant SE, whereas the other effect sizes were small. Numerous studies in clinical and non-clinical populations also Ethical Standards found significant associations of SE and SC with paranoia but, The authors assert that all procedures contributing to this as this study pointed out, depressive symptoms boosted these work comply with the ethical standards of the relevant national associations, and effect sizes must be reported to quantify the and institutional committees on human experimentation and magnitude of the relationship (76, 77). Only then a clearer picture with the Helsinki Declaration of 1975, as revised in 2008. All of the association between self-representation and paranoia can participants provided an informed consent. be obtained. Concerning the limitations of this study, its cross-sectional DATA AVAILABILITY STATEMENT nature prevents drawing conclusions about causal effects. Furthermore, given that the participants are pursuing a The raw data supporting the conclusions of this article will be Psychology degree, it is possible that their psychological made available by the authors, without undue reservation. knowledge and the awareness of some phenomena may bias their reports and also limits the generalizability of the findings ETHICS STATEMENT to community samples. Another limitation of the study is that an a priori power analysis to determine sample sizes was not The studies involving human participants were reviewed and performed. Finally, it has been argued that implicit SE is only approved by the Ethics Committee of the Universitat Autònoma an impoverished measure of explicit SE and it should not be de Barcelona (Comissió d’Ética en l’Experimentació Animal i labeled as such (78). Although the GNAT overcame some of Humana (CEEAH); number 701H-JS). The patients/participants the weaknesses of previous measures of implicit SE, the precise provided their written informed consent to participate in nature of the unconscious self-related association that the GNAT, this study. or other implicit SE tasks, assesses is still a matter of debate. Further research is needed for a better understanding of the AUTHOR CONTRIBUTIONS measures that seek to delve into the non-conscious psychological processes. Similarly, further studies should be carried out in MM, SB, and NB-V conceived the study. SB, TS, and NB-V order to gain more in-depth knowledge about SE discrepancies interviewed participants and collected data. MM and TK in clinical and subclinical paranoia, as reducing maladaptive SE analyzed the data. MM, TK, and NB-V wrote the paper. TS, CV, discrepancies could be an effective strategy to reduce paranoid and RE critically revised the manuscript. All authors contributed ideation (37, 79). to the article and approved the submitted version. 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No use, distribution or 48:1021–31. doi: 10.1007/s00127-013-0700-4 reproduction is permitted which does not comply with these terms. Frontiers in Psychiatry | www.frontiersin.org 10 March 2021 | Volume 12 | Article 623755