Discrepancies between ideal and actual affect predict negative symptoms in schizophrenia in daily life: An ecological momentary assessment study.

Limited progress in treating negative symptoms in schizophrenia (SZ) may stem from an imprecise mechanistic understanding of these symptoms. This study tests a newly proposed hypothesis about a novel psychological mechanism-that negative symptoms result from discrepancies between ideal and actual affect. Greater trait discrepancies between how one wants to feel versus how one actually feels have previously been associated with greater negative symptom severity. This study uses Ecological Momentary Assessment (EMA) to determine whether these effects extend to daily life contexts. Thirty-nine outpatients with SZ and 33 healthy controls (CN) completed 7 days of EMA surveys assessing negative symptoms and ideal-actual affect discrepancies for positive and negative affect. SZ had greater ideal-actual negative but not positive affect discrepancies in daily life, suggesting SZ feel more negative affect than they desire to than CN. A greater discrepancy between one's ideal and actual negative and positive affect was associated with greater concurrent anhedonia and avolition. Time-lagged analyses showed a greater discrepancy between ideal-actual positive and negative affect was uniquely tied to higher levels of prospective anhedonia in SZ. The strength of the discrepancy between ideal and actual affect also varied across activity, social partner, and location contexts. The greater discrepancy between how positive and negative a person with SZ wants to feel may result in feeling defeated and demotivated, contributing to reduced engagement in goal-directed and pleasurable activities. This discrepancy between ideal and actual affect is a novel mechanistic target for negative symptoms that could be targeted with just-in-time digital therapeutics.