A cognitive model of persecutory delusions

Freeman, Daniel; Garety, Philippa; Kuipers, Elizabeth; Fowler, David; Bebbington, Paul

doi:10.1348/014466502760387461

Cited by 702 publications

(708 citation statements)

References 75 publications

(56 reference statements)

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“…It is clear that anxiety is implicated across both cognitive and affective dimensions of paranoia, which is consistent with predictions of several cognitive models (Garety et al 2001;Morrison, 2001;Freeman et al 2002;Morrison et al 2011). Depression would be expected to be associated with paranoid conviction on the basis of several theories (Bentall et al 2001;Garety et al 2001;Morrison, 2001;Freeman et al 2002), while depressed mood would be expected to be associated with deservedness according to other predictions (Trower & Chadwick, 1995;Melo et al 2009); we found clear support for the former hypothesis and not the latter.…”

Section: Discussionsupporting

confidence: 86%

“…However, the relationship between negative beliefs about self and our dimensions of paranoia was the opposite, showing a differential relationship with deservedness and not paranoid ideation. This finding is consistent with specific predictions about deservedness (Trower & Chadwick, 1995;Melo et al 2009) but the lack of association with paranoid conviction is inconsistent with some models of paranoia (Bentall et al 2001;Garety et al 2001;Morrison, 2001;Freeman et al 2002) and with previous findings from patients with long-standing psychosis Bentall et al 2009), although previous studies have not generally considered paranoia and deservedness separately. The most likely explanation for the discrepancies between the findings is that the relationship between paranoia, feelings of deservedness and selfesteem are dynamic and vary during the progression of a psychotic illness.…”

Section: Discussionsupporting

confidence: 74%

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Negative cognition, affect, metacognition and dimensions of paranoia in people at ultra-high risk of psychosis: a multi-level modelling analysis

et al. 2015

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n Morrison, A.P. et al. (2015) Negative cognition, affect, metacognition and dimensions of paranoia in people at ultra-high risk of psychosis: a multi-level modelling analysis. Psychological Medicine, 45(12), pp. 2675-2684.There may be differences between this version and the published version. You are advised to consult the publisher's version if you wish to cite from it.http://eprints.gla.ac.uk/109839/ Background. Paranoia is one of the commonest symptoms of psychosis but has rarely been studied in a population at risk of developing psychosis. Based on existing theoretical models, including the proposed distinction between 'poor me' and 'bad me' paranoia, we aimed to test specific predictions about associations between negative cognition, metacognitive beliefs and negative emotions and paranoid ideation and the belief that persecution is deserved (deservedness).Method. We used data from 117 participants from the Early Detection and Intervention Evaluation for people at risk of psychosis (EDIE-2) trial of cognitive-behaviour therapy, comparing them with samples of psychiatric in-patients and healthy students from a previous study. Multi-level modelling was utilized to examine predictors of both paranoia and deservedness, with post-hoc planned comparisons conducted to test whether person-level predictor variables were associated differentially with paranoia or with deservedness.Results. Our sample of at-risk mental state participants was not as paranoid, but reported higher levels of 'bad-me' deservedness, compared with psychiatric in-patients. We found several predictors of paranoia and deservedness. Negative beliefs about self were related to deservedness but not paranoia, whereas negative beliefs about others were positively related to paranoia but negatively with deservedness. Both depression and negative metacognitive beliefs about paranoid thinking were specifically related to paranoia but not deservedness.Conclusions. This study provides evidence for the role of negative cognition, metacognition and negative affect in the development of paranoid beliefs, which has implications for psychological interventions and our understanding of psychosis.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 74%

Negative cognition, affect, metacognition and dimensions of paranoia in people at ultra-high risk of psychosis: a multi-level modelling analysis

et al. 2015

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“…It has been long proposed that delusions serve as explanations for odd or strange internal experience (Maher, 1974). Furthermore, perceptual anomalies are incorporated within a cognitive model of paranoid delusions, where paranoid beliefs arise from an attempt to explain anomalous and odd internal experiences (Freeman et al, 2002). Indeed, research has shown that perceptual anomalies increase the risk for the development of delusional ideas (Krabbendam et al, 2004) and anomalies of experience caused by illegal drug use have also been linked to delusional ideation (D'Souza et al, 2004).…”

Section: Perceptual Anomalies and Paranoiamentioning

confidence: 99%

“…More recently, Sheaves et al (2016) showed that insomnia was associated with perceptual anomalies (hallucinations), even after controlling for negative emotions. Furthermore, perceptual distortions are considered central to paranoia (Freeman et al, 2002). No direct test of this exists although cannabis use which can induce anomalous experiences partially mediates the relationship between insomnia and paranoia (Freeman et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

Sleep quality and paranoia: The role of alexithymia, negative emotions and perceptual anomalies

Rehman

Gumley

Biello

2018

Psychiatry Research

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A B S T R A C TRecent evidence suggests that sleep problems are associated with psychotic like experiences including paranoia. However, the mechanisms underpinning this association are not well understood and thus studies modelling hypothesised mediating factors are required. Alexithymia, the inability to recognise and describe emotions within the self may be an important candidate. In two separate studies we sought to investigate factors mediating the relationship between sleep quality and paranoia using a cross-sectional design. Healthy volunteers without a mental health diagnosis were recruited (study 1, N = 401, study 2, N = 402). Participants completed a series of measures assessing paranoia, negative emotions, alexithymia and perceptual anomalies in an online survey. In study 1, regression and mediation analyses showed that the relationship between sleep quality and paranoia was partially mediated by alexithymia, perceptual anomalies and negative affect. In contrast, study 2 found that the relationship between sleep quality and paranoia was fully mediated by negative affect, alexithymia and perceptual anomalies. The link between sleep quality and paranoia is unclear and reasons for discrepant results are discussed. Novel findings in this study include the link between alexithymia and paranoia.

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“…A multifactorial approach is taken, with the specific goal of moving towards a greater understanding of cognitive and affective contributing factors. Given a theoretical account that proposes that problems of affect may act as important drivers of persisting psychosis (Freeman, Garety, Kuipers, Fowler, & Bebbington, 2002), recent research has examined the role of anxiety and related processes in delusion formation and persistence (e.g. Startup, Freeman, & Garety, 2007).…”

Section: Introduction: Persecutory Delusionsmentioning

confidence: 99%

Cognitive factors maintaining persecutory delusions in psychosis: The contribution of depression.

Vorontsova¹,

Garety²,

Freeman³

2013

Journal of Abnormal Psychology

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Depression is common in people with schizophrenia, but how it might directly contribute to the persistence of psychotic symptoms has rarely been tested. The key aim of the present study was to test whether depression and associated cognitive processes predict the maintenance of persecutory delusions. Three groups of participants were tested at baseline: 60 patients with persecutory delusions in the context of a schizophrenia spectrum diagnosis, 30 patients with depression, and 30 nonclinical controls. They completed interviewer and self-report assessments of depression and paranoia, and measures of six cognitive factors (schematic beliefs, experiential avoidance, autobiographical memory, problem solving, rumination, worry style). The patients with persecutory delusions were then assessed again, six months later. It was found that 50% of the patients with persecutory delusions met diagnostic criteria for major depression. Cognitive processes found to be associated with depression across the groups were negative schematic beliefs about the self, experiential avoidance and rumination, but not autobiographical memory or problem solving. The severity of initial depression in patients with persecutory delusions predicted the persistence of paranoia over six months. A number of cognitive factors also predicted the persistence of persecutory delusions, including negative schematic beliefs about the self, worry, and problem-solving difficulties. In conclusion, depression is common in patients with current persecutory delusions, and it shows similar cognitive features to major depressive disorder. The results of this study indicate that depression and related processes may contribute to the maintenance of paranoia. Trials are warranted of depression-related therapeutic techniques for people with persecutory delusions.

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A cognitive model of persecutory delusions

Cited by 702 publications

References 75 publications

Negative cognition, affect, metacognition and dimensions of paranoia in people at ultra-high risk of psychosis: a multi-level modelling analysis

Negative cognition, affect, metacognition and dimensions of paranoia in people at ultra-high risk of psychosis: a multi-level modelling analysis

Sleep quality and paranoia: The role of alexithymia, negative emotions and perceptual anomalies

Cognitive factors maintaining persecutory delusions in psychosis: The contribution of depression.

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