Impact of attachment imagery on paranoia and mood: evidence from two single case studies

Abstract

Background: Cognitive behavioural therapy (CBT) for psychosis currently yields modest outcomes and must be improved. Attachment imagery may be an effective means of reducing severity of paranoid beliefs and associated affect. Experimental studies have demonstrated these effects in non-clinical groups. The impact in clinical populations remains untested. Aims: This study assessed the impact of a brief attachment imagery task on paranoia and mood, in two people with a diagnosis of schizophrenia. Method: Two single case studies are presented. Both participants were working age adults with persecutory delusions. The study utilised an A-B-A design. Participants were recruited for a 6-week period, with a 2- and 3-week baseline respectively, 1-week intervention phase, and follow-up phase matched to duration of baseline. Trait paranoia and attachment were measured at the start of the baseline. State paranoia and affect were measured daily over the 6-week period. Results: For both participants, the baseline phase was characterised by high and variable levels of paranoia, which reduced during the intervention phase, with a return to baseline scores at follow-up. We found a similar pattern for negative affect, and the reverse pattern for positive affect. Conclusions: Attachment imagery may function as an effective emotion regulation strategy for people with psychosis. Continued use is likely to be needed to maintain gains. This brief task could prove valuable to people needing skills to manage paranoia and mood, and give clinicians confidence that people can manage short-term distress in CBT for psychosis, for example when addressing past trauma.

The Impact of Repeated Attachment Priming on Paranoia, Mood and Help-Seeking Intentions in an Analogue Sample

“…These results add to the growing body of literature demonstrating that security priming reduces paranoia and negative affect in people with elevated and clinical levels of paranoia and the role of potential causal mechanisms [31][32][33][34][35]. This is the first study to demonstrate the effects of repeated priming in a sample with high trait paranoia and replicates initial evidence of the impact on help-seeking intentions in this group [32].…”

“…Together, these studies show that attachment security priming reduces paranoia and distress [30][31][32][33][34][35] and that cognitive fusion is a mediating mechanism in the attachmentparanoia association [32,33].…”

“…Initial studies investigating the benefits of attachment security priming for paranoia in analogue groups [30][31][32][33] and preliminary clinical samples [34,35] show that security priming reduces state paranoia and negative affect and increases positive affect and selfesteem. Importantly, security priming reduces state paranoia for people high in trait attachment avoidance and for people high in trait attachment anxiety [32].…”

How does attachment imagery for paranoia work? Cognitive fusion and beliefs about self and others mediate the impact on paranoia and anxiety

“…State anxiety and cognitive fusion decreased from pre‐ to post‐imagery in the secure imagery group and increased in the anxious and avoidant groups with moderate effects. These results align with research demonstrating that secure imagery reduces paranoia in individuals with non‐clinical paranoia (Newman‐Taylor et␣al., 2017) and a diagnosis of schizophrenia (Pitfield et␣al., 2020). The results are consistent with research showing that, relative to insecure/threat imagery, secure attachment imagery reduces state paranoia and anxiety via reduced cognitive fusion (Sood & Newman‐Taylor, 2020).…”

“…When people with high non-clinical paranoia are primed to feel secure and trusting of others, their paranoia and anxiety decrease, whereas when primed to feel suspicious and untrusting of others, paranoia and anxiety increase (Bullock, Newman-Taylor, & Stopa, 2016;Newman-Taylor, Kemp, Potter, & Au-Yeung, 2017;. Similarly, case studies of people with schizophrenia demonstrate that security priming decreases paranoia and negative affect (Pitfield, Maguire, & Newman-Taylor, 2020). Attachment styles may therefore inform our understanding of the development and maintenance of paranoia, and attachment priming may augment psychological therapies.…”