An early Phase II randomised controlled trial testing the effect on persecutory delusions of using CBT to reduce negative cognitions about the self: The potential benefits of enhancing self confidence

Abstract

BackgroundResearch has shown that paranoia may directly build on negative ideas about the self. Feeling inferior can lead to ideas of vulnerability. The clinical prediction is that decreasing negative self cognitions will reduce paranoia.MethodThirty patients with persistent persecutory delusions were randomised to receive brief CBT in addition to standard care or to standard care (ISRCTN06118265). The six session intervention was designed to decrease negative, and increase positive, self cognitions. Assessments at baseline, 8 weeks (posttreatment) and 12 weeks were carried out by a rater blind to allocation. The primary outcomes were posttreatment scores for negative self beliefs and paranoia. Secondary outcomes were psychological well-being, positive beliefs about the self, persecutory delusions, social comparison, self-esteem, anxiety, and depression.ResultsTrial recruitment and retention were feasible and the intervention highly acceptable to the patients. All patients provided follow-up data. Posttreatment there was a small reduction in negative self beliefs (Cohen's d = 0.24) and a moderate reduction in paranoia (d = 0.59), but these were not statistically significant. There were statistically significant improvements in psychological well-being (d = 1.16), positive beliefs about the self (d = 1.00), negative social comparison (d = 0.88), self-esteem (d = 0.62), and depression (d = 0.68). No improvements were maintained. No adverse events were associated with the intervention.ConclusionsThe intervention produced short-term gains consistent with the prediction that improving cognitions about the self will reduce persecutory delusions. The improvement in psychological well-being is important in its own right. We recommend that the different elements of the intervention are tested separately and that the treatment is lengthened.

Negative schemata about the self and others and paranoid ideation in at‐risk states and those with persisting positive symptoms

“…The presented results support schema‐based diagnostic efforts and psychotherapy in patients at CHR with high suspiciousness scores in early detection and intervention centres and in individuals with persecutory delusions within clinical settings (Braehler et al, ; Freeman et al, ).…”

“…A simple explanation for this finding would be that NS and other scores in the PPS sample may have been below the average means found in other studies. (Fowler et al, 2011;Fowler et al, 2006;Freeman et al, 2014;Garety et al, 2012;Hodgekins & Fowler, 2010;MacKinnon, Newman-Taylor, & Stopa, 2011;Onwumere et al, 2009;Smith et al, 2006;Taylor et al, 2014) Given the fact that patients with higher positive and general symptoms-scores from the PPS sample had the tendency to not returning their BCSS questionnaires, we may have underestimated the factor NS. Thus, we cannot neglect the possibility that the lack of association of NS schemata with paranoia in the presented PPS sample is attributable to lower NS-scores.…”

Expressive suppression is associated with state paranoia in psychosis: An experience sampling study on the association between adaptive and maladaptive emotion regulation strategies and paranoia

“…This has notable implications for new approaches to cognitive therapy for psychosis (CBTp) that adopt the ‘interventionist causal approach’ (Kendler & Campbell, ). These newer approaches to CBTp refrain from challenging delusional beliefs directly, for example paranoia and focus on change in putative causal factors of delusional beliefs, like sleep quality (Freeman, Waite, et al ., 2015), self‐esteem (Freeman et al ., ), or worrying (Freeman, Dunn, et al ., 2015). If future studies confirm the causal role of maladaptive ER processes in the formation and maintenance of paranoia, the improvement of ER skills could be a promising new treatment target of CBTp.…”

Self‐Compassion and Self‐Criticism in Recovery in Psychosis: An Interpretative Phenomenological Analysis Study

“…The themes in the current study centre on negative self‐relating and how this may maintain distressing psychotic symptoms; therefore, negative‐self‐cognitions and affect are identified as valid and important treatment targets in psychological therapy. The reduction of negative cognitions about the self has been the focus of recent developments in CBTp (Freeman et al., ). The current study, therefore, lends support to the application of CBTp and therapies that promote acceptance and compassion to facilitate recovery in psychosis.…”