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<jats:p><jats:bold>Background:</jats:bold> Paranoia may build directly upon negative thoughts about the self. There have been few direct experimental tests of this hypothesis. <jats:bold>Aims:</jats:bold> The aim of the study was to test the immediate effects of manipulating self-esteem in individuals vulnerable to paranoia. <jats:bold>Method:</jats:bold> A two condition cross-over experimental test was conducted. The participants were 26 males reporting paranoid ideation in the past month. Each participant experienced a neutral immersive virtual reality (VR) social environment twice. Before VR participants received a low self-confidence manipulation or a high self-confidence manipulation. The order of manipulation type was randomized. Paranoia about the VR avatars was assessed. <jats:bold>Results:</jats:bold> The low self-confidence manipulation, relative to the high self-confidence manipulation, led to significantly more negative social comparison in virtual reality and higher levels of paranoia. <jats:bold>Conclusions:</jats:bold> Level of self-confidence affects the occurrence of paranoia in vulnerable individuals. The clinical implication is that interventions designed to improve self-confidence may reduce persecutory ideation.</jats:p>

Original publication




Journal article


Behavioural and Cognitive Psychotherapy


Cambridge University Press (CUP)

Publication Date





56 - 64