Anxiety symptoms, rule learning, and cognitive flexibility in non-clinical psychosis

Individuals with psychotic-like experiences (PLEs) represent a critical group for improving the understanding of vulnerability factors across the psychosis continuum. A growing body of literature has identified functional deficits associated with PLEs. However, it is unclear if such deficits purely reveal the underlying psychosis vulnerability or if they are also linked with comorbid anxiety symptoms. Although anxiety disorders are often associated with impairments in psychosis-risk, symptoms of anxiety may facilitate executive functioning in certain psychosis groups. The Community Assessment of Psychic Experiences was completed to assess psychosis-like symptoms in a total of 57 individuals, and its median score was used to categorize PLE groups (high-PLE = 24, low-PLE = 33). Anxiety symptoms were measured via the Beck Anxiety Inventory, and cognitive flexibility was measured by the Penn Conditional Exclusion Test. The high-PLE group endorsed more anxiety symptoms, demonstrated poorer accuracy and efficiency on the cognitive task, and made more perseverative errors compared to the low-PLE group. Within the high-PLE group, higher levels of anxiety symptoms were associated with better performance and less perseverative errors compared to individuals with lower levels of anxiety symptoms. Conversely, greater anxiety symptoms were associated with poorer performance in the low-PLE group. Taken together, these findings provide a preliminary support for a potential psychosis vulnerability × anxiety symptom interaction. Given the interest in the psychosis continuum and potential treatment implications, the present findings warrant replication efforts.