Maladaptive emotion regulation strategies and more pronounced instability of negative emotions are relevant to paranoia in patients with psychosis and should be a special focus of CBTp interventions. Future interventions designed for patients suffering from paranoia should promote coping with unstable negative emotions and replacing or reducing maladaptive emotion regulation strategies with adaptive ones.
The findings support the feasibility of the experimental design to manipulate loneliness and suggest that loneliness could be a cause of paranoia. However, the findings need to be confirmed in high risk samples to draw conclusions about the role of loneliness in the genesis of clinically relevant levels of paranoia and derive implications for cognitive behaviour therapy.
Although instable negative emotions and problems in emotion regulation (ER) are common in patients with psychosis and are discussed as potential factors involved in the formation and maintenance of paranoia, it is unclear whether they increase the risk of developing paranoia in nonclinical controls. The present study aims to investigate whether the instability of negative emotions leads to paranoia in healthy participants. It should be further analyzed if the application of maladaptive ER strategies enhances subclinical paranoid ideation and if the use of adaptive ER strategies reduces subclinical paranoid ideation. Method: Nonclinical controls ( n = 83) repeatedly reported the presence and instability of negative emotions, paranoia, and the use of maladaptive (expressive suppression, rumination) and adaptive (reappraisal, acceptance) ER strategies in their daily life on six consecutive days using electronic mobile assessment. Results: Hierarchical linear regression analysis revealed that nonclinical controls reporting a pronounced instability of negative emotions showed more pronounced paranoia at a subsequent time point. Moreover, participants who used expressive suppression at a certain time experienced more severe paranoia at the subsequent time point. Conclusion: If these findings are confirmed in high-risk samples, ER processes could be considered as an additional factor in theoretical models of paranoia formation.
Background
Cognitive Behavior Therapy for psychosis (CBTp) effectively reduces positive symptoms, but the effects for delusions are small. Using approaches that focus on improving putative causal factors of delusions (emotion regulation (ER) and negative self-schemata) may be a way to improve CBTp for delusions.
Objectives
To pilot an emotion-focused CBTp intervention comprised of elements of different third wave approaches targeting ER and negative self-schemata (CBT-E) to investigate its feasibility and its potential efficacy.
Methods
A single-blind two-centered randomized wait-list controlled trial was performed. Patients with delusions in the context of a psychotic disorder (n=64) were randomized to CBT-E (treatment group (TG): n=35) or wait list (WL: n=29). TG received individual CBT-E in weekly sessions over six months, WL received CBT-E after a 6-months waiting time. Assessments were performed at baseline, after six months, and after 12 months.
Results
Rates of patients who consented and retained in CBT-E suggest acceptable feasibility and high acceptance of CBT-E. Multiple regression analysis in the intent-to-treat sample revealed no significant advantage in favor of TG in the primary outcome delusions (PSYRATS delusions), no effect on ER or negative self-schemata and a significant advantage in only one of the eight additional secondary outcome variables, namely general psychopathology.
Discussion
Although the intervention was feasible and acceptable, its effects on delusions did not hold up with the effects found for ‘targeted’ approaches in previous research and it needs to be improved to produce a stronger effect on the targets ER and self-schemata, before proceeding to a large-scale RCT.
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