Objective: Low self-esteem has been suggested as a putative mechanism in the development and maintenance of psychosis. Uncertainty still exists about how unstable self-esteem relates to psychotic experiences. The present study examines the potential (temporal) associations between momentary self-esteem, fluctuations in self-esteem, and psychotic experiences in daily life. Methods: Experience sampling data were collected from 46 individuals presenting with an at-risk mental state (ARMS), 51 individuals with first-episode psychosis (FEP), and 53 controls, to investigate associations between (fluctuations in) self-esteem and psychotic experiences within and across FEP, ARMS, and controls, using linear mixed models. Results: In all three groups we found that lower momentary self-esteem was associated with a greater intensity of psychotic experiences (adj. βFEP = −0.15, 95% CI -0.20 to −0.10, p = 0.000; adj. βARMS = −0.20, 95% CI -0.26 to −0.15, p = 0.000; adj. βcontrols = −0.12, 95% CI -0.17 to −0.07, p = 0.000). Variability in momentary self-esteem was associated with a greater intensity of psychotic experiences only in ARMS (adj. βARMS = 0.08, 95% CI 0.04 to 0.11, p = 0.000) and controls (adj. βcontrols = 0.04, 95% CI 0.01 to 0.08, p = 0.023). For instability this association held only in controls (adj. βcontrols = 0.03, 95% CI 0.00 to 0.05, p = 0.020). Furthermore, findings may suggest a reciprocal temporal association between self-esteem and psychotic experiences. Conclusions: Our findings suggest that self-esteem may be an important mechanism targetable by ecological momentary interventions to reduce the intensity of psychotic experiences and potentially prevent illness progression at an early stage.

Original languageEnglish
Pages (from-to)188-198
Number of pages11
JournalSchizophrenia Research
Early online date14 Nov 2021
Publication statusPublished - Dec 2021


  • Ecological momentary assessment
  • First-episode psychosis
  • Mechanism
  • Prodrome
  • Self-esteem


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