A randomised controlled trial of a worry intervention for individuals with persistent persecutory delusions

Abstract

Recent research has shown that worry is associated with distressing paranoia. Therefore, the aim was to target worry in a therapeutic intervention for individuals with delusions. It was predicted that a worry intervention would reduce levels of worry and paranoia distress. Twenty-four individuals with persistent persecutory delusions and high levels of worry were randomly assigned to receive a four session cognitive-behavioural worry intervention (W-CBT) or treatment as usual (TAU). The worry intervention was specifically designed not to target the content of delusions. In this open-label evaluation, assessments of worry and paranoia were conducted at baseline, at one month (end of treatment) and at two months. The worry intervention achieved a statistically significant reduction in worry which was maintained at two month follow up. A significant reduction in delusional distress was also reported. There was an indication that the worry intervention may also reduce the frequency of paranoid thoughts but this was not statistically significant. In the first trial specifically for persecutory delusions, a brief worry intervention was shown to have benefits. The results support a causal role for worry in paranoid experience.

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

“…It has previously been found that worry can predict the persistence of delusions over time (Startup et al, 2007) and that treating worry in psychological therapy can reduce the distress associated with persecutory delusions (Foster et al, 2010) The results of the present study suggest that those people with delusions who have high levels of worry might also have high levels of depression. However, this was an exploratory finding of the present study, with no corresponding a priori hypothesis, and as such cannot be said to generalize to the population beyond the present sample.…”

“…The positive results that were found, particularly regarding worry predicting delusion persistence (Startup et al, 2007), led to small-scale trials of worry interventions for people with persecutory delusions (Foster, Startup, Potts, & Freeman, 2010;Hepworth, Startup, & Freeman, 2011). It was found that both worry and delusion severity could be reduced using short-term CBT, targeting worry, even without directly challenging the content of persecutory beliefs.…”

“…The only trial targeting self esteem that didn't find positive symptom reductions had started with a participant group with already minimal positive symptoms, as mentioned above (Laithwaite et al, 2009). Lecomte et al's (1999) anxiety has now received attention in a series of studies supporting the roles of attention to threat (Freeman, Garety, & Phillips, 2000), worry (Startup et al, 2007;Foster et al, 2010) and the use of safety behaviours …”

“…Furthermore, a randomised controlled trial of a psychological intervention reducing worry in people with persecutory delusions also achieved significant reductions in delusional distress and a trend towards reductions in the frequency of paranoid thoughts (Foster et al, 2010). Hepworth et al (2011) proposed that worry and rumination exert a negative impact on delusions through a detrimental impact on emotional processing.…”

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

“…First, our findings suggest that cognitive behavioural assessments should include an examination of anxiety, depression, negative beliefs about self and others and metacognitive beliefs about paranoia. Given the associations we observed between negative emotions and paranoia, treatment of anxiety and depression within their own right (using strategies such as worry reduction and behavioural activation) may have beneficial effects on paranoid conviction; the first of these strategies has already been shown to be successful in patients with persecutory delusions (Foster et al 2010;Freeman et al 2015). Interventions aimed at improving self-esteem have been shown to be applicable to people with psychosis (Hall & Tarrier, 2003;Freeman et al 2014), and such approaches may well have an effect on affective dimensions of paranoia such as deservedness.…”