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Behavioural and Cognitive Psychotherapy Jan 2022Negative beliefs about the self, including low self-compassion, have been identified as a putative causal factor in the occurrence of paranoia. Therefore, improving...
BACKGROUND
Negative beliefs about the self, including low self-compassion, have been identified as a putative causal factor in the occurrence of paranoia. Therefore, improving self-compassion may be one route to reduce paranoia.
AIMS
To assess the feasibility, acceptability, and potential clinical effects of a brief compassionate imagery intervention for patients with persecutory delusions.
METHOD
Twelve patients with persecutory delusions received an individual four-session compassionate imagery intervention. Assessments of self-concept and paranoia were completed before treatment, immediately after treatment, and at 1-month follow-up. A qualitative study exploring participants' experiences of the treatment was also completed.
RESULTS
Twelve out of 14 eligible patients referred to the study agreed to take part. All participants completed all therapy sessions and assessments. Post-treatment, there were improvements in self-compassion (change score -0.64, 95% CI -1.04, -0.24, d = -1.78), negative beliefs about the self (change score 2.42, 95% CI -0.37, 5.20, d = 0.51), and paranoia (change score 10.08, 95% CI 3.47, 16.69, d = 0.61). There were no serious adverse events. Three themes emerged from the qualitative analysis: 'effortful learning', 'seeing change' and 'taking it forward'. Participants described a process of active and effortful engagement in therapy which was rewarded with positive changes, including feeling calmer, gaining clarity, and developing acceptance.
CONCLUSION
This uncontrolled feasibility study indicates that a brief compassionate imagery intervention for patients with persecutory delusions is feasible, acceptable, and may lead to clinical benefits.
Topics: Delusions; Empathy; Humans; Imagery, Psychotherapy; Paranoid Disorders; Self-Compassion
PubMed: 34078499
DOI: 10.1017/S1352465821000229 -
PLoS Computational Biology Jul 2022Theoretical accounts suggest heightened uncertainty about the state of the world underpin aberrant belief updates, which in turn increase the risk of developing a...
Theoretical accounts suggest heightened uncertainty about the state of the world underpin aberrant belief updates, which in turn increase the risk of developing a persecutory delusion. However, this raises the question as to how an agent's uncertainty may relate to the precise phenomenology of paranoia, as opposed to other qualitatively different forms of belief. We tested whether the same population (n = 693) responded similarly to non-social and social contingency changes in a probabilistic reversal learning task and a modified repeated reversal Dictator game, and the impact of paranoia on both. We fitted computational models that included closely related parameters that quantified the rigidity across contingency reversals and the uncertainty about the environment/partner. Consistent with prior work we show that paranoia was associated with uncertainty around a partner's behavioural policy and rigidity in harmful intent attributions in the social task. In the non-social task we found that pre-existing paranoia was associated with larger decision temperatures and commitment to suboptimal cards. We show relationships between decision temperature in the non-social task and priors over harmful intent attributions and uncertainty over beliefs about partners in the social task. Our results converge across both classes of model, suggesting paranoia is associated with a general uncertainty over the state of the world (and agents within it) that takes longer to resolve, although we demonstrate that this uncertainty is expressed asymmetrically in social contexts. Our model and data allow the representation of sociocognitive mechanisms that explain persecutory delusions and provide testable, phenomenologically relevant predictions for causal experiments.
Topics: Delusions; Humans; Learning; Paranoid Disorders; Social Learning; Uncertainty
PubMed: 35877675
DOI: 10.1371/journal.pcbi.1010326 -
Schizophrenia Bulletin Sep 2016Psychotic disorders and major depression, both typically adult-onset conditions, often co-occur. At younger ages psychotic experiences and depressive symptoms are often...
Psychotic disorders and major depression, both typically adult-onset conditions, often co-occur. At younger ages psychotic experiences and depressive symptoms are often reported in the community. We used a genetically sensitive longitudinal design to investigate the relationship between psychotic experiences and depressive symptoms in adolescence. A representative community sample of twins from England and Wales was employed. Self-rated depressive symptoms, paranoia, hallucinations, cognitive disorganization, grandiosity, anhedonia, and parent-rated negative symptoms were collected when the twins were age 16 (N = 9618) and again on a representative subsample 9 months later (N = 2873). Direction and aetiology of associations were assessed using genetically informative cross-lagged models. Depressive symptoms were moderately correlated with paranoia, hallucinations, and cognitive disorganization. Lower correlations were observed between depression and anhedonia, and depression and parent-rated negative symptoms. Nonsignificant correlations were observed between depression and grandiosity. Largely the same genetic effects influenced depression and paranoia, depression and hallucinations, and depression and cognitive disorganization. Modest overlap in environmental influences also played a role in the associations. Significant bi-directional longitudinal associations were observed between depression and paranoia. Hallucinations and cognitive disorganization during adolescence were found to impact later depression, even after controlling for earlier levels of depression. Our study shows that psychotic experiences and depression, as traits in the community, have a high genetic overlap in mid-adolescence. Future research should test the prediction stemming from our longitudinal results, namely that reducing or ameliorating positive and cognitive psychotic experiences in adolescence would decrease later depressive symptoms.
Topics: Adolescent; Depressive Disorder, Major; Diseases in Twins; Female; Hallucinations; Humans; Longitudinal Studies; Male; Paranoid Disorders; Psychotic Disorders
PubMed: 26994398
DOI: 10.1093/schbul/sbw021 -
Schizophrenia Bulletin Sep 2022Influential models of psychosis indicate that the impact of putative causal factors on positive symptoms might be explained partly through affective disturbances. We...
BACKGROUND AND HYPOTHESIS
Influential models of psychosis indicate that the impact of putative causal factors on positive symptoms might be explained partly through affective disturbances. We aimed to investigate whether pathways from stress and self-esteem to positive symptoms, as well as reversal pathways from symptoms to stress and self-esteem, were mediated through specific affective disturbances across the extended psychosis phenotype.
STUDY DESIGN
Using experience sampling methodology, 178 participants (65 high-schizotypy, 74 at-risk mental state, and 39 first-episode psychosis) were assessed on levels of momentary stress, self-esteem, anxiety, sadness, psychotic-like experiences (PLE), and paranoia. Multilevel mediation models were fit to examine indirect effects of each of these pathways. Considering evidence of mediation, each indirect pathway will be combined in a single model to explore their relative contributions.
STUDY RESULTS
Anxiety, sadness, and self-esteem mediated the pathways from stress to PLE and paranoia in daily-life. In the pathway to paranoia, sadness, and self-esteem showed larger contributions than anxiety. Pathways from self-esteem to PLE and paranoia were mediated by anxiety and sadness, the later showing a larger contribution. Pathways from symptoms to stress, but not from symptoms to self-esteem, were differently explained by emotional states; sadness lost its mediating effect and anxiety was the most important mediator. Few differences across groups were found.
CONCLUSIONS
This study lends support to psychological models of psychosis that highlight the relevance of affective disturbances in the risk and expression of psychosis. Furthermore, specific influences of different negative emotional states were identified, which could enhance psychological treatments.
Topics: Anxiety; Emotions; Humans; Paranoid Disorders; Psychotic Disorders; Self Concept
PubMed: 35759215
DOI: 10.1093/schbul/sbac071 -
Psychology and Psychotherapy Sep 2021Paranoia is known to be associated with insecure attachment, with negative self-esteem as a mediator, but this pathway is insufficient to explain the paranoid...
OBJECTIVES
Paranoia is known to be associated with insecure attachment, with negative self-esteem as a mediator, but this pathway is insufficient to explain the paranoid individual's beliefs about malevolent others. Mistrust is a likely additional factor as it is a core feature of paranoid thinking also associated with insecure attachment styles. In this study, we tested whether mistrust - operationalized as judgements about the trustworthiness of unfamiliar faces - constitutes a second pathway from insecure attachment to paranoia.
DESIGN
The design of the study was cross-sectional.
METHODS
A nationally representative British sample of 1,508 participants aged 18-86, 50.8% female, recruited through the survey company Qualtrics, completed measurements of attachment style, negative self-esteem, and paranoid beliefs. Usable data were obtained from 1,121 participants. Participants were asked to make trustworthiness judgements about computer-generated faces, and their outcomes were analysed by conducting signal detection analysis, which provided measures of bias (the tendency to assume untrustworthiness in conditions of uncertainty) and sensitivity (accuracy in distinguish between trustworthy and untrustworthy faces).
RESULTS
Results using structural equation modelling revealed a good model fit (RMSEA = .071, 95% CI: 0.067-0.075, SRMR = .045, CFI = .93, TLI = .92). We observed indirect effects through bias towards mistrust both for the relationship between attachment anxiety and avoidance (β = .003, 95% CI: 0.001-0.005,p < .001) and attachment anxiety and paranoia (β = .003, 95% CI 0.002-0.006, p < .001). We observed an indirect effect through negative self-esteem only for the relationship between attachment anxiety and paranoia (β = .064, 95% CI: 0.053-0.077, p < .001). Trust judgements and negative self-esteem were not associated with each other.
CONCLUSIONS
We find that a bias towards mistrust is associated with greater paranoia. We also find indirect effects through bias towards mistrust between attachment styles and paranoia. Finally, we reaffirm the strong indirect effect through negative self-esteem between attachment anxiety and paranoia. Limitations of the study are discussed.
PRACTITIONER POINTS
When working with individuals suffering from paranoia, clinicians should consider not only explicit, deliberative cognitive processes of the kind addressed in cognitive behaviour therapy (e.g. cognitive restructuring) but also the way in which their patients make perceptual judgements (e.g., their immediate reactions on encountering new people) and consider interventions targeted at these judgements, for example, bias modification training. Assessment and clinical interventions for people should consider the role of trust judgements and the way in which they combine with low self-esteem to provoke paranoid beliefs. Psychological interventions targeting paranoid beliefs should focus on both attachment anxiety and attachment avoidance.
Topics: Anxiety; Anxiety Disorders; Cross-Sectional Studies; Female; Humans; Male; Paranoid Disorders; Self Concept
PubMed: 33314565
DOI: 10.1111/papt.12314 -
PloS One 2021Expressed emotion (EE) and self-esteem (SE) have been implicated in the onset and development of paranoia and positive symptoms of psychosis. However, the impact of EE...
Expressed emotion (EE) and self-esteem (SE) have been implicated in the onset and development of paranoia and positive symptoms of psychosis. However, the impact of EE on patients' SE and ultimately on symptoms in the early stages of psychosis is still not fully understood. The main objectives of this study were to examine whether: (1) patients' SE mediated the effect of relatives' EE on patients' positive symptoms and paranoia; (2) patients' perceived EE mediated the effect of relatives' EE on patients' SE; (3) patients' SE mediated between patients' perceived EE and patients' symptomatology; and (4) patients' perceived EE and patients' SE serially mediated the effect of relatives' EE on patients' positive symptoms and paranoia. Incipient psychosis patients (at-risk mental states and first-episode of psychosis) and their respective relatives completed measures of EE, SE, and symptoms. Findings indicated that: (1) patients' perceived EE mediated the link between relatives' EE and patients' negative, but not positive, SE; (2) patients' negative SE mediated the effect of patients' perceived EE on positive symptoms and paranoia; (3) the association of relatives' EE with positive symptoms and paranoia was serially mediated by an increased level of patients' perceived EE leading to increases in negative SE; (4) high levels of patients' distress moderated the effect of relatives' EE on symptoms through patients' perceived EE and negative SE. Findings emphasize that patients' SE is relevant for understanding how microsocial environmental factors impact formation and expression of positive symptoms and paranoia in early psychosis. They suggest that broader interventions for patients and their relatives aiming at improving family dynamics might also improve patients' negative SE and symptoms.
Topics: Adaptation, Psychological; Adolescent; Adult; Anxiety; Expressed Emotion; Family Relations; Female; Humans; Interpersonal Relations; Male; Psychotic Disorders; Self Concept; Young Adult
PubMed: 33819314
DOI: 10.1371/journal.pone.0249721 -
Frontiers in Psychology 2023
PubMed: 37425168
DOI: 10.3389/fpsyg.2023.1205350 -
American Journal of Alzheimer's Disease... Nov 2018Folie à deux is a clinical condition that was first described in 19th century. It is a psychotic disorder in which two closely associated individuals share a similar... (Review)
Review
BACKGROUND
Folie à deux is a clinical condition that was first described in 19th century. It is a psychotic disorder in which two closely associated individuals share a similar delusional system.
OBJECTIVES
The aim of this article is to review the nosological significance of folie à deux and to explore the disorder among patients with dementia.
METHODS
Medline and Google Scholar searches were conducted for relevant articles, chapters, and books published before 2017. Search terms used included dementia, folie à deux, induced delusional disorder, neurocognitive disorders, shared psychotic disorder. Publications found through this indexed search were reviewed for further relevant references.
RESULTS AND CONCLUSION
Cases of Folie à deux involving patients with dementia are reported quite infrequently. Most of the studies on the topic consist in case reports. Clinicians are obliged to treat the disorder. They should be alert to the potential high risk inherent this psychotic syndrome.
Topics: Delusions; Dementia; Humans; Interpersonal Relations; Risk Factors; Shared Paranoid Disorder; Social Isolation
PubMed: 29772920
DOI: 10.1177/1533317518772060 -
Psychological Medicine Oct 2023Paranoia is common in clinical and nonclinical populations, consistent with continuum models of psychosis. A number of experimental studies have been conducted that... (Meta-Analysis)
Meta-Analysis Review
Paranoia is common in clinical and nonclinical populations, consistent with continuum models of psychosis. A number of experimental studies have been conducted that attempt to induce, manipulate or measure paranoid thinking in both clinical and nonclinical populations, which is important to understand causal mechanisms and advance psychological interventions. Our aim was to conduct a systematic review and meta-analysis of experimental studies (non-sleep, non-drug paradigms) on psychometrically assessed paranoia in clinical and nonclinical populations. The review was conducted using PRISMA guidelines. Six databases (PsycINFO, PubMed, EMBASE, Web of Science, Medline and AMED) were searched for peer-reviewed experimental studies using within and between-subject designs to investigate paranoia in clinical and nonclinical populations. Effect sizes for each study were calculated using Hedge's and were integrated using a random effect meta-analysis model. Thirty studies were included in the review (total = 3898), which used 13 experimental paradigms to induce paranoia; 10 studies set out to explicitly induce paranoia, and 20 studies induced a range of other states. Effect sizes for individual studies ranged from 0.03 to 1.55. Meta-analysis found a significant summary effect of 0.51 [95% confidence interval 0.37-0.66, < 0.001], indicating a medium effect of experimental paradigms on paranoia. Paranoia can be induced and investigated using a wide range of experimental paradigms, which can inform decision-making about which paradigms to use in future studies, and is consistent with cognitive, continuum and evolutionary models of paranoia.
Topics: Humans; Psychotic Disorders; Paranoid Disorders; Sleep
PubMed: 37427557
DOI: 10.1017/S0033291723001708 -
Journal of Rational-emotive and... May 2023Childhood adversity (CA) and resilience may impact on paranoia, but mechanisms underlying these associations are largely unknown. In this study, we investigated two...
UNLABELLED
Childhood adversity (CA) and resilience may impact on paranoia, but mechanisms underlying these associations are largely unknown. In this study, we investigated two potential candidates: irrational beliefs and affective disturbance. Moreover, we investigated the potential moderating role of COVID-19 perceived stress in these associations. A community sample ( = 419, age = 27.32 years, = 8.98; 88.10% females) completed self-report measures. Results indicated that paranoia was significantly associated with CA and resilience ( < .05), and both irrational beliefs and affective disturbance (i.e., depressive and anxiety symptoms) mediated the associations between CA and paranoia. Moreover, depressive and anxiety symptoms partially explained the mediating role of irrational beliefs. These predictive models explained up to 23.52% of variance in paranoia ((3,415) = 42.536, < .001). Findings on resilience and paranoia replicated these results, and COVID-19 perceived stress moderated the association between resilience and ideas of persecution. Overall, these findings underscore the importance of irrational beliefs, depressive and anxiety symptoms in high CA or low resilience individuals experiencing paranoia.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s10942-023-00511-4.
PubMed: 37360924
DOI: 10.1007/s10942-023-00511-4