{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T17:44:21Z","timestamp":1773769461974,"version":"3.50.1"},"reference-count":67,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T00:00:00Z","timestamp":1773705600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Refugees are chronically exposed to cumulative stress, which may increase allostatic load (AL) and vulnerability to psychotic-like experiences (PLEs). Belief inflexibility, reflecting difficulties in revising beliefs in response to new information, may influence how physiological stress affects psychosis proneness. This study examined whether AL index interacts with cognitive biases and refugee status in predicting PLEs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Sixty Ukrainian refugees and fifty matched controls underwent psychiatric evaluation, assessment of cognitive biases, and measurement of AL biomarkers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Refugees had fewer years of education and showed higher depressive, anxiety, PLEs, trauma-related symptoms, greater belief inflexibility and elevated AL index. Significant positive correlations were found between AL index and PLEs and between AL index and belief inflexibility. Moderation analyses revealed that both AL index and belief inflexibility were positively associated with PLEs, and refugee status amplified these effects. However, the interaction between AL index and belief inflexibility was negative, suggesting that higher cognitive rigidity weakened the direct impact of physiological stress on PLEs. Subsequent analyses indicated that this attenuating effect was especially pronounced in the refugee group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>These findings highlight the complex interplay between stress physiology andcognitive style in shaping psychosis vulnerability and adaptation in trauma exposed refugee populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2026.1761027","type":"journal-article","created":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T14:40:11Z","timestamp":1773758411000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Belief inflexibility reduces the impact of allostatic overload on psychotic-like experiences among Ukrainian refugees"],"prefix":"10.3389","volume":"17","author":[{"given":"Julian","family":"Maciaszek","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Wroclaw Medical University","place":["Wroclaw, Poland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Aleinikova","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Wroclaw Medical University","place":["Wroclaw, Poland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agnieszka","family":"Dybek","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Wroclaw Medical University","place":["Wroclaw, Poland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B\u0142a\u017cej","family":"Misiak","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Wroclaw Medical University","place":["Wroclaw, Poland"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1017\/dmp.2022.70","article-title":"The new humanitarian crisis in Ukraine: coping with the public health impact of hybrid warfare, mass migration, and mental health trauma","volume":"16","author":"Patel","year":"2022","journal-title":"Disaster Med Public Health Prep"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1016\/S0018-506X(02)00024-7","article-title":"The concept of allostasis in biology and biomedicine","volume":"43","author":"McEwen","year":"2003","journal-title":"Horm Behav"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1016\/j.neubiorev.2009.10.002","article-title":"Allostatic load biomarkers of chronic stress and impact on health and cognition","volume":"35","author":"Juster","year":"2010","journal-title":"Neurosci Biobehav Rev"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.12740\/PP\/24448","article-title":"The role of allostatic load in the development of psychiatric disorders","volume":"47","author":"Bizik","year":"2013","journal-title":"Psychiatr Pol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291720000555","article-title":"The association between allostatic load and psychological distress in the general population","volume":"51","author":"Honkalampi","year":"2021","journal-title":"Psychol Med"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.2147\/NDT.S64681","article-title":"Allostatic load and its association with cognitive performance in individuals with mood disorders","volume":"10","author":"Misiak","year":"2014","journal-title":"Neuropsychiatr Dis Treat"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/j.1749-6632.2003.tb03425.x","article-title":"Stress, adaptations, and disease: allostasis and allostatic load","volume":"992","author":"McEwen","year":"2003","journal-title":"Ann N Y Acad Sci"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2022.02.003","article-title":"Allostatic load and mortality: a systematic review and meta-analysis","volume":"63","author":"Parker","year":"2022","journal-title":"Am J Prev Med"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.psyneuen.2022.105725","article-title":"Allostatic load in the context of disasters","volume":"140","author":"Sandifer","year":"2022","journal-title":"Psychoneuroendocrinology"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2019.1937","article-title":"Risk of psychosis among refugees: a systematic review and meta-analysis","volume":"76","author":"Brandt","year":"2019","journal-title":"JAMA Psychiatry"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2003.11.018","article-title":"Hypocortisolism and increased glucocorticoid sensitivity of pro-inflammatory cytokine production in Bosnian war refugees with PTSD","volume":"55","author":"Rohleder","year":"2004","journal-title":"Biol Psychiatry"},{"key":"B12","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/j.jadohealth.2003.08.005","article-title":"Trauma and coping in Somali and Oromo refugee youth","volume":"35","author":"Halc\u00f3n","year":"2004","journal-title":"J Adolesc Health"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.comppsych.2023.152438","article-title":"The associations of hair cortisol and DHEA with PTSD symptoms in refugees","volume":"129","author":"de Graaff","year":"2024","journal-title":"Compr Psychiatry"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1097\/YCO.0000000000000497","article-title":"Psychosis and urbanicity: a review of recent literature from epidemiology to neurourbanism","volume":"32","author":"Fett","year":"2019","journal-title":"Curr Opin Psychiatry"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2025.1590547","article-title":"Allostatic load index across the psychosis spectrum: a systematic review and meta-analysis","volume":"16","author":"Madaria","year":"2025","journal-title":"Front Psychiatry"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291720003219","article-title":"The incidence of psychotic disorders among migrants and ethnic minorities in Europe: findings from the multinational EU-GEI study","volume":"52","author":"Termorshuizen","year":"2022","journal-title":"Psychol Med"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1111\/acps.13147","article-title":"Age at migration and the risk of psychotic disorders: a systematic review and meta-analysis","volume":"141","author":"Anderson","year":"2020","journal-title":"Acta Psychiatr Scand"},{"key":"B18","doi-asserted-by":"publisher","first-page":"678","DOI":"10.1186\/s12888-025-06979-x","article-title":"Prevalence of psychotic-like experiences among Afghan migrant children and adolescents","volume":"25","author":"Rezaee","year":"2025","journal-title":"BMC Psychiatry"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1126\/science.185.4157.1124","article-title":"Judgment under uncertainty: heuristics and biases","volume":"185","author":"Tversky","year":"1974","journal-title":"Science"},{"key":"B20","doi-asserted-by":"crossref","DOI":"10.1017\/S1352465806002852","article-title":"Cognitive processes, reasoning biases and persecutory delusions: a comparative study","volume":"34","author":"Fraser","year":"2006","journal-title":"Behav Cognit Psychother"},{"key":"B21","doi-asserted-by":"publisher","first-page":"e0246948","DOI":"10.1371\/journal.pone.0246948","article-title":"Childhood trauma and cognitive biases associated with psychosis: a systematic review and meta-analysis","volume":"16","author":"Shah","year":"2021","journal-title":"PloS One"},{"key":"B22","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1016\/j.schres.2020.06.016","article-title":"Cognitive biases in individuals with psychotic-like experiences: a systematic review and meta-analysis","volume":"222","author":"Livet","year":"2020","journal-title":"Schizophr Res"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2009.1","article-title":"The cognitive and affective structure of paranoid delusions: a transdiagnostic investigation of patients with schizophrenia spectrum disorders and depression","volume":"66","author":"Bentall","year":"2009","journal-title":"Arch Gen Psychiatry"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.113.126953","article-title":"The past and future of delusions research: from the inexplicable to the treatable","volume":"203","author":"Garety","year":"2013","journal-title":"Br J Psychiatry"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroscience.2016.06.005","article-title":"Neural underpinnings of cognitive flexibility","volume":"345","author":"Waltz","year":"2017","journal-title":"Neuroscience"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2020.609569","article-title":"Inflexibility in reasoning: comparisons of cognitive flexibility, explanatory flexibility, and belief flexibility between schizophrenia and major depressive disorder","volume":"11","author":"Zhu","year":"2021","journal-title":"Front Psychiatry"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbv150","article-title":"JTC bias meta-analysis","volume":"42","author":"Dudley","year":"2016","journal-title":"Schizophr Bull"},{"key":"B28","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1111\/bjc.12154","article-title":"Belief inflexibility meta-analysis","volume":"57","author":"Zhu","year":"2018","journal-title":"Br J Clin Psychol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2018.04.023","article-title":"Cognitive biases moderating affect\u2013PLE links","volume":"265","author":"Prochwicz","year":"2018","journal-title":"Psychiatry Res"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2014.10.006","article-title":"Cognitive biases mediate temperament\u2013PLE links","volume":"225","author":"Gaw\u0119da","year":"2015","journal-title":"Psychiatry Res"},{"key":"B31","doi-asserted-by":"crossref","DOI":"10.1016\/j.brat.2005.06.007","article-title":"Need for closure and anxiety in early psychosis","volume":"44","author":"Colbert","year":"2006","journal-title":"Behav Res Ther"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1097\/01.nmd.0000221353.44132.25","article-title":"Need for closure and decisiveness in delusion-prone individuals","volume":"194","author":"McKay","year":"2006","journal-title":"J Nerv Ment Dis"},{"key":"B33","doi-asserted-by":"publisher","first-page":"287","DOI":"10.12740\/PP\/131533","article-title":"The relationships of need for closure dimensions with psychotic-like experiences and jumping to conclusions.  study of a large cross-population sample","volume":"55","author":"Daren","year":"2021","journal-title":"Psychiatr Pol"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbm013","article-title":"A bias against disconfirmatory evidence is associated with delusion proneness in a nonclinical sample","volume":"33","author":"Woodward","year":"2007","journal-title":"Schizophr Bull"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1080\/13546800802099033","article-title":"Belief inflexibility in schizophrenia","volume":"13","author":"Woodward","year":"2008","journal-title":"Cognit Neuropsychiatry"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbw056","article-title":"Association of the jumping to conclusions and evidence integration biases with delusions in psychosis: a detailed meta-analysis","volume":"43","author":"McLean","year":"2017","journal-title":"Schizophr Bull"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1523\/JNEUROSCI.0716-18.2018","article-title":"Updating beliefs under perceived threat","volume":"38","author":"Garrett","year":"2018","journal-title":"J Neurosci"},{"key":"B38","first-page":"22","article-title":"The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10","volume":"59","author":"Sheehan","year":"1998","journal-title":"J Clin Psychiatry"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbs068","article-title":"Validity of the 16-item prodromal questionnaire (PQ-16)","volume":"38","author":"Ising","year":"2012","journal-title":"Schizophr Bull"},{"key":"B40","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1016\/j.schres.2012.12.010","article-title":"Development of the davos assessment of cognitive biases scale (DACOBS)","volume":"144","author":"van der Gaag","year":"2013","journal-title":"Schizophr Res"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing GAD: the GAD-7","volume":"166","author":"Spitzer","year":"2006","journal-title":"Arch Intern Med"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1961.01710120031004","article-title":"An inventory for measuring depression","volume":"4","author":"Beck","year":"1961","journal-title":"Arch Gen Psychiatry"},{"key":"B43","first-page":"399","article-title":"The impact of event scale\u2013revised","volume-title":"Assessing psychological trauma and PTSD","author":"Weiss","year":"1997"},{"key":"B44","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1093\/clinchem\/18.6.499","article-title":"Estimation of LDL cholesterol without ultracentrifugation","volume":"18","author":"Friedewald","year":"1972","journal-title":"Clin Chem"},{"key":"B45","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1097\/HRP.0000000000000001","article-title":"Allostatic load as a tool for monitoring physiological dysregulations in severe mental illness","volume":"21","author":"Bizik","year":"2013","journal-title":"Harv Rev Psychiatry"},{"key":"B46","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1016\/j.psyneuen.2017.12.019","article-title":"Allostatic load is associated with psychotic symptoms and decreases with antipsychotic treatment","volume":"90","author":"Berger","year":"2018","journal-title":"Psychoneuroendocrinology"},{"key":"B47","volume-title":"Introduction to mediation, moderation, and conditional process analysis: a regression-based approach","author":"Hayes","year":"2018"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.3758\/BF03193146","article-title":"G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences","volume":"39","author":"Faul","year":"2007","journal-title":"Behav Res Methods"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1007\/s40615-017-0368-7","article-title":"Stress measured by allostatic load score varies by reason for immigration","volume":"5","author":"Utumatwishima","year":"2018","journal-title":"J Racial Ethn Health Disparities"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17124533","article-title":"Allostatic load varies by immigration factors","volume":"17","author":"Hormenu","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1002\/wcs.1222","article-title":"Stress and cognition","volume":"4","author":"Sandi","year":"2013","journal-title":"Wiley Interdiscip Rev Cognit Sci"},{"key":"B52","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2022.976140","article-title":"Childhood adversity, allostatic load, and adult mental health: a systematic review","volume":"13","author":"Finlay","year":"2022","journal-title":"Front Psychiatry"},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291709006020","article-title":"Social determinants of psychosis in migrants","volume":"40","author":"Morgan","year":"2010","journal-title":"Psychol Med"},{"key":"B54","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1017\/S0033291722000454","article-title":"Psychotic experiences in the general population: a review","volume":"52","author":"Staines","year":"2022","journal-title":"Psychol Med"},{"key":"B55","doi-asserted-by":"publisher","DOI":"10.1037\/a0025297","article-title":"Jumping to conclusions, a lack of belief flexibility and delusional conviction in psychosis: a longitudinal investigation of the structure, frequency, and relatedness of reasoning biases","volume":"121","author":"So","year":"2012","journal-title":"J Abnorm Psychol"},{"key":"B56","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2022.844891","article-title":"Meaning making following trauma","volume":"13","author":"Park","year":"2022","journal-title":"Front Psychol"},{"key":"B57","volume-title":"Shattered assumptions: towards a new psychology of trauma","author":"Janoff-Bulman","year":"1992"},{"key":"B58","first-page":"81","article-title":"Schema-change perspectives on posttraumatic growth","volume-title":"Handbook of posttraumatic growth: research and practice","author":"Janoff-Bulman","year":"2010"},{"key":"B59","doi-asserted-by":"publisher","DOI":"10.1002\/jclp.23272","article-title":"A longitudinal investigation of the meaning-making model in midlife adults who have experienced trauma","volume":"77","author":"Fitzke","year":"2021","journal-title":"J Clin Psychol"},{"key":"B60","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291701003312","article-title":"A cognitive model of the positive symptoms of psychosis","volume":"31","author":"Garety","year":"2001","journal-title":"Psychol Med"},{"key":"B61","doi-asserted-by":"publisher","DOI":"10.1017\/S003329170700013X","article-title":"Implications for neurobiological research of cognitive models of psychosis: a theoretical paper","volume":"37","author":"Garety","year":"2007","journal-title":"Psychol Med"},{"key":"B62","doi-asserted-by":"publisher","first-page":"e56345","DOI":"10.7554\/eLife.56345","article-title":"Paranoia as a deficit in non-social belief updating","volume":"9","author":"Reed","year":"2020","journal-title":"eLife"},{"key":"B63","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2022.814111","article-title":"Models of dynamic belief updating in psychosis \u2014 a review across different computational approaches","volume":"13","author":"Katthagen","year":"2022","journal-title":"Front Psychiatry"},{"key":"B64","doi-asserted-by":"publisher","DOI":"10.1038\/s41562-021-01176-8","article-title":"Paranoia and belief updating during the COVID-19 crisis","volume":"5","author":"Suthaharan","year":"2021","journal-title":"Nat Hum Behav"},{"key":"B65","doi-asserted-by":"publisher","DOI":"10.1038\/nn.2949","article-title":"How unrealistic optimism is maintained in the face of reality","volume":"14","author":"Sharot","year":"2011","journal-title":"Nat Neurosci"},{"key":"B66","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.tics.2015.11.002","article-title":"Forming beliefs: why valence matters","volume":"20","author":"Sharot","year":"2016","journal-title":"Trends Cognit Sci"},{"key":"B67","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291713001074","article-title":"Depression is related to an absence of optimistically biased belief updating about future life events","volume":"44","author":"Korn","year":"2014","journal-title":"Psychol Med"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1761027\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T14:40:13Z","timestamp":1773758413000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1761027\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,17]]},"references-count":67,"alternative-id":["10.3389\/fpsyt.2026.1761027"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2026.1761027","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,17]]},"article-number":"1761027"}}