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Advances in Schizophrenia Research 2009
Cognitive and Social Processes in Psychosis: Recent Developments Daniel Freeman In general I'm paranoid about almost everything. Every nice compliment or ...
Content and affect in persecutory delusions
Objectives. The study aimed to explore the content of persecutory delusions and its potential links with levels of affective disturbance. Detailed examinations of the phenomenology of delusional beliefs have been rare, but are important for furthering theoretical and clinical understanding. Design. A cross-sectional investigation of 70 individuals with current persecutory delusions was conducted. Methods. Taped semi-structured clinical interviews were transcribed for each participant. Using a coding frame devised for the current study, a detailed description of persecutory content was made. Scores on the Beck Depression and Anxiety Inventories, the Rosenberg Self-esteem Scale and the Psychotic Symptom Rating Scales were used as indicators of emotional distress. Results. Data were gathered on the identity and type of persecutor, pervasiveness of threat and the power of the persecutor. Reliability was good. Beliefs involving multiple persecutors, human in nature and identifiable to the individual were common. For the majority threat was severe, ongoing and enduring and coupled with frequent feelings of vulnerability. Specific aspects of delusional content were found to be associated with emotional distress. For example, if participants felt more power in the face of persecution this was coupled with lower depression and higher self-esteem. Conclusions. Persecutory delusions are beliefs concerning severe threat, particularly of physical harm including death, which is personally significant, frequently involving multiple persecutors known to the individual. Depression is higher in those who felt less powerful than their persecutors. Associations, such as this, with emotional distress support a direct role for emotion in delusion formation and maintenance. It is consistent with cognitive models of delusions which emphasize the importance of considering emotional distress in the context of belief appraisal, although interpretation of the results is limited by the cross-sectional study design. Recognizing these links may in turn aid therapists in identifying aspects of beliefs that might be targeted to facilitate emotional change. © 2006 The British Psychological Society.
A cognitive model of persecutory delusions
A multifactorial model of the formation and maintenance of persecutory delusions is presented. Persecutory delusions are conceptualized as threat beliefs. The beliefs are hypothesized to arise from a search for meaning for internal or external experiences that are unusual, anomalous, or emotionally significant for the individual. The persecutory explanations formed reflect an interaction between psychotic processes, pre-existing beliefs and personality (particularly emotion), and the environment. It is proposed that the delusions are maintained by processes that lead to the receipt of confirmatory evidence and processes that prevent the processing of disconfirmatory evidence. Novel features of the model include the (non-defended) direct roles given to emotion in delusion formation, the detailed consideration of both the content and form of delusions, and the hypotheses concerning the associated emotional distress. The clinical and research implications of the model are outlined.
Developing treatments of persistent persecutory delusions: The impact of an emotional processing and metacognitive awareness intervention
Worry has been implicated in increasing the levels of distress associated with persecutory delusions. It may partly cause this distress via the impediment of emotional processing of upsetting experiences. The clinical implication is that enhancing emotional processing of paranoid experiences will reduce distress. We therefore piloted a new brief intervention-the Emotional Processing and Metacognitive Awareness (EPMA)-on 12 patients with persistent persecutory delusions. The intervention was predominately influenced by written emotional disclosure and lasted for three sessions. The delusions were assessed at baseline, preintervention and postintervention and during a one-month follow-up. It was found that EPMA particularly reduced levels of delusion distress, and this was maintained at follow-up. The effect sizes were large but were likely overestimated given the absence of a control group and assessments that were not blind. These preliminary findings suggest that simply encouraging patients to talk, in the right way, about their delusions can be beneficial. © 2011 by Lippincott Williams and Wilkins.
Persecutory ideation and a history of cannabis use
Background: Cannabis use is associated with the occurrence of psychotic experiences. However there are multiple distinct psychotic experiences, each likely to occur as quantitative traits in the general population. In this study we tested for an association of cannabis use with a dimensional assessment of persecutory ideation. Method: A total of 1714 individuals from the general population completed a dimensional measure of current persecutory ideation and reported on whether they had ever taken cannabis. Results: Of all participants, 648 (38%) reported a history of cannabis use. These individuals reported significantly higher current levels of persecutory ideation. The amount of variance in paranoia scores explained was low. Individuals with a history of cannabis use had almost twice the odds of reporting any paranoid ideation in the past month compared with individuals who had never taken cannabis. Conclusions: Using a state of the art assessment, the study adds to findings of an association of persecutory ideation with cannabis use. © 2013 Elsevier B.V.
Developing a theoretical understanding of therapy techniques: An illustrative analogue study
Objectives. In psychological interventions, clients are often asked to review unhelpful beliefs. Surprisingly, there is no theoretical understanding of how beliefs are reviewed in therapy. Moreover, by understanding a therapeutic technique, potential interactions with symptom processes can be considered. An analogue study assessing the feasibility of researching therapy techniques is described, in which links between symptoms, reasoning style, and an experimental version of the cognitive therapy technique of belief evaluation are examined. Design. Individuals without psychiatric illness (N = 30) completed (i) dimensional measures of depression, anxiety, and delusions, (ii) a measure of confirmatory reasoning (Wason's 2-4-6 task) both before and after instruction in disconfirmatory reasoning, and (iii) a belief evaluation task. Results. Compared with individuals with a confirmatory reasoning style, individuals with a disconfirmatory reasoning style in Wason's task were less hasty in their data gathering, considered a greater number of hypotheses during the task, had higher intellectual functioning, and had lower levels of depressive symptoms. Conversely, the individuals with the strongest confirmatory reasoning had higher levels of depression and preoccupation with delusional ideation. Successful adoption of disconfirmatory reasoning was associated with less hasty decision-making and lower levels of preoccupation and distress by delusional ideation. Individuals with a disconfirmatory reasoning style reported more evidence both for and against their beliefs in the belief evaluation task. Conclusion. The preliminary evidence, from this small non-clinical group, indicates that evaluating beliefs may partially involve the use of confirmatory and disconfirmatory reasoning processes. Disconfirmatory reasoning, associated with less hasty data gathering and consideration of alternatives, may lead to better belief evaluation. In the context of clinical research indicating that individuals with delusions are hasty in their data gathering and have difficulty considering alternatives, a potential implication of the findings is that individuals with delusions may find belief evaluation in therapy particularly difficult. The current study has clear limitations, but a research focus on specific techniques of therapy does appear feasible and show promise. © 2005 The British Psychological Society.
The prediction of hallucinatory predisposition in non-clinical individuals: Examining the contribution of emotion and reasoning
Background. Emotion, especially anxiety, has been implicated in triggering hallucinations. Reasoning processes are also likely to influence the judgments that lead to hallucinatory experiences. We report an investigation of the prediction of hallucinatory predisposition by emotion and associated processes (anxiety, depression, stress, self-focused attention) and reasoning (need for closure, extreme responding). Method. Data were analysed from a questionnaire survey in a student population (N = 327). Results. Higher levels of anxiety, self-focus, and extreme responding were associated with hallucinatory predisposition. Interactions between these three variables did not strengthen the predictive effect of each. Depression, stress, and need for closure were not found to be predictors of hallucinatory experience in the regression analysis. Conclusion. Emotional and reasoning processes may both need to be considered in the understanding of hallucinatory experience. © 2005 The British Psychological Society.
Bullying victimisation and risk of psychotic phenomena: Analyses of British national survey data
© 2015 Elsevier Ltd. Background: Being bullied is an aversive experience with short-term and long-term consequences, and is incorporated in biopsychosocial models of psychosis. We used the 2000 and the 2007 British Adult Psychiatric Morbidity Surveys to test the hypothesis that bullying is associated with individual psychotic phenomena and with psychosis, and predicts the later emergence of persecutory ideation and hallucinations. Methods: We analysed two nationally representative surveys of individuals aged 16 years or older in Great Britain (2000) and England (2007). Respondents were presented with a card listing stressful events to identify experiences of bullying over the entire lifespan. We assessed associations with the dependent variables persecutory ideation, auditory and visual hallucinations, and diagnosis of probable psychosis. All analyses were controlled for sociodemographic confounders, intelligence quotient (IQ), and other traumas. Findings: We used data for 8580 respondents from 2000 and 7403 from 2007. Bullying was associated with presence of persecutory ideation and hallucinations, remaining so after adjustment for sociodemographic factors, IQ, other traumas, and childhood sexual abuse. Bullying was associated with a diagnosis of probable psychosis. If reported at baseline, bullying predicted emergence and maintenance of persecutory ideation and hallucinations during 18 months of follow-up in the 2000 survey. Controlling for other traumas and childhood sexual abuse did not affect the association between bullying and psychotic symptoms, but reduced the significance of the association with diagnosis of probable psychosis. Bullying was most strongly associated with the presence of concurrent persecutory ideation and hallucinations. Interpretation: Bullying victimisation increases the risk of individual psychotic symptoms and of a diagnosis of probable psychosis. Early detection of bullying and use of treatments oriented towards its psychological consequences might ameliorate the course of psychosis.
Psychotic experiences are linked to cannabis use in adolescents in the community because of common underlying environmental risk factors
© 2015 The Authors. Cannabis users are more likely to have psychotic experiences (PEs). The degree to which these associations are driven by genetic or environmental influences in adolescence is unknown. This study estimated the genetic and environmental contributions to the relationship between cannabis use and PEs. Specific PEs were measured in a community-based twin sample (4830 16-year-old pairs) using self-reports and parent-reports. Adolescents reported on ever using cannabis. Multivariate liability threshold structural equation model-fitting was conducted. Cannabis use was significantly correlated with PEs. Modest heritability (37%), common environmental influences (55%) and unique environment (8%) were found for cannabis use. For PEs, modest heritability (27-54%), unique environmental influences (. E=12-50%) and little common environmental influences (11-20%), with the exception of parent-rated Negative Symptoms (42%), were reported. Environmental influences explained all of the covariation between cannabis use and paranoia, cognitive disorganization and parent-rated negative symptoms (bivariate common environment=69-100%, bivariate unique environment=28-31%), whilst the relationship between cannabis use and hallucinations indicated familial influences. Cannabis use explains 2-5% of variance in positive, cognitive, and negative PEs. Cannabis use and psychotic experience co-occur due to environmental factors. Focus on specific environments may reveal why adolescent cannabis use and psychotic experiences tend to 'travel together'.
Advances in understanding and treating persecutory delusions: A review
Purpose: Persecutory delusions are a central psychotic experience, at the severe end of a paranoia spectrum in the general population. The aim of the review is to provide an introduction to the understanding of persecutory delusions, highlight key putative causal factors that have the potential to be translated into efficacious treatment, and indicate future research directions. Methods: A narrative literature review was undertaken to highlight the main recent areas of empirical study concerning non-clinical and clinical paranoia. Results: Six main proximal causal factors are identified: a worry thinking style, negative beliefs about the self, interpersonal sensitivity, sleep disturbance, anomalous internal experience, and reasoning biases. Each has plausible mechanistic links to the occurrence of paranoia. These causal factors may be influenced by a number of social circumstances, including adverse events, illicit drug use, and urban environments. Conclusions: There have been numerous replicated empirical findings leading to a significant advance in the understanding of persecutory delusions, now beginning to be translated into cognitive treatments. The first trials specifically focussed on patients who have persecutory delusions in the context of psychotic diagnoses are occurring. Initial evidence of efficacy is very promising. © 2014 The Author(s).
Persecutory delusions and psychological well-being
Purpose: Persecutory delusions are one of the key problems seen in psychotic conditions. The aim of the study was to assess for the first time the levels of psychological well-being specifically in patients with current persecutory delusions. Method: One hundred and fifty patients with persecutory delusions in the context of a diagnosis of non-affective psychosis, and 346 non-clinical individuals, completed the Warwick-Edinburgh Mental Well-Being Scale and symptom assessments. Results: Well-being scores were much lower in the persecutory delusions group compared with the non-clinical control group. 47 % of the persecutory delusions group scored lower than two standard deviations below the control group mean score. Within the patient group, psychological well-being was negatively associated with depression, anxiety, and hallucinations. In both groups, lower levels of well-being were associated with more severe paranoia. Conclusions: Levels of psychological well-being in patients with current persecutory delusions are strikingly low. This is likely to arise from the presence of affective symptoms and psychotic experiences. Measurement of treatment change in positive mental health for patients with psychosis is recommended. © 2013 Springer-Verlag Berlin Heidelberg.
Psychological characteristics of religious delusions
Purpose: Religious delusions are common and are considered to be particularly difficult to treat. In this study we investigated what psychological processes may underlie the reported treatment resistance. In particular, we focused on the perceptual, cognitive, affective and behavioural mechanisms held to maintain delusions in cognitive models of psychosis, as these form the key treatment targets in cognitive behavioural therapy. We compared religious delusions to delusions with other content. Methods: Comprehensive measures of symptoms and psychological processes were completed by 383 adult participants with delusions and a schizophrenia spectrum diagnosis, drawn from two large studies of cognitive behavioural therapy for psychosis. Results: Binary logistic regression showed that religious delusions were associated with higher levels of grandiosity (OR 7.5; 95 % CI 3.9-14.1), passivity experiences, having internal evidence for their delusion (anomalous experiences or mood states), and being willing to consider alternatives to their delusion (95 % CI for ORs 1.1-8.6). Levels of negative symptoms were lower. No differences were found in delusional conviction, insight or attitudes towards treatment. Conclusions: Levels of positive symptoms, particularly anomalous experiences and grandiosity, were high, and may contribute to symptom persistence. However, contrary to previous reports, we found no evidence that people with religious delusions would be less likely to engage in any form of help. Higher levels of flexibility may make them particularly amenable to cognitive behavioural approaches, but particular care should be taken to preserve self-esteem and valued aspects of beliefs and experiences. © 2013 Springer-Verlag Berlin Heidelberg.
The interaction of affective with psychotic processes: A test of the effects of worrying on working memory, jumping to conclusions, and anomalies of experience in patients with persecutory delusions
Worry has traditionally been considered in the study of common emotional disorders such as anxiety and depression, but recent studies indicate that worry may be a causal factor in the occurrence and persistence of persecutory delusions. The effect of worry on processes traditionally associated with psychosis has not been tested. The aim of the study was to examine the short-term effects of a bout of worry on three cognitive processes typically considered markers of psychosis: working memory, jumping to conclusions, and anomalous internal experience. Sixty-seven patients with persecutory delusions in the context of a non-affective psychotic disorder were randomised to a worry induction, a worry reduction, or a neutral control condition. They completed tests of the cognitive processes before and after the randomisation condition. The worry induction procedure led to a significant increase in worry. The induction of worry did not affect working memory or jumping to conclusions, but it did increase a range of mild anomalous experiences including feelings of unreality, perceptual alterations, and temporal disintegration. Worry did not affect the occurrence of hallucinations. The study shows that a period of worry causes a range of subtle odd perceptual disturbances that are known to increase the likelihood of delusions. It demonstrates an interaction between affective and psychotic processes in patients with delusions. © 2013 Elsevier Ltd.