Interpretation Bias in Paranoia: A Systematic Review and Meta-Analysis

Abstract

More than 10% of the general population regularly experience paranoid thoughts. Persecutory delusions occur in one third of psychiatric patients in the United Kingdom and are associated with severe clinical and social impairment. Furthermore, individuals with elevated vulnerability to paranoia interpret ambiguous environmental information more negatively than those with low vulnerability, a cognitive phenomenon called interpretation bias. We conducted a systematic review and meta-analysis of the association between interpretation bias and paranoia. Twenty studies were included, and our meta-analysis indicated that a negative interpretation bias was associated with paranoia both in clinical (standardized mean difference, or SMD = 1.01; 95% confidence interval [CI] = [0.51, 1.52], p < .001) and nonclinical populations ( SMD = 1.06; 95% CI = [0.28, 1.85], p = .008). Our results also showed that higher negative interpretation bias was positively correlated with the severity of paranoia, and results were consistent in nonclinical ( r = .32; 95% CI = [.21, .43], p < .001) and clinical samples ( r = .38; 95% CI = [.27, .48], p < .001). These findings might orient prevention strategies and psychological interventions for paranoia.

Conjecturing Harmful Intent and Preemptive Strike in Paranoia

“…However, a belief that the opponent has competitive motives is irrational because a choice to attack is costly for them. This finding also supports the argument that paranoia reflects an irrational interpretation bias that others have harmful intentions ( Kramer, 1994 ; Garety and Freeman, 1999 ; Combs et al, 2007 ; Lopes et al, 2018 ; Murphy et al, 2018 ; Trotta et al, 2021 ). The weak and insignificant association between paranoia and prediction of other’s fear may reflect an inclination of people with paranoia to pay more attention to the hostility of others than to their anxiety.…”

“…Paranoia is associated with a tendency to over-attribute negative events to other’s personalistic negative intentions rather than situational factors ( Garety and Freeman, 1999 ; Murphy et al, 2018 ; Trotta et al, 2021 ). Studies using hypothetical scenarios, in which the causes of negative events were ambiguous, have shown that people with higher levels of paranoid ideation are likely to rate others’ intentions as hostile than those with lower levels ( Combs et al, 2007 ).…”

Preliminary Outcomes of an Ecological Momentary Intervention for Social Functioning in Schizophrenia: Pre-Post Study of the Motivation and Skills Support App

“…Active intervention components, such as social goal support, could have served to reduce the potential for ambiguity in social interactions through increased structure and predictability. This structured support could have further reduced feelings of suspiciousness, given the higher likelihood of interpretation biases in ambiguous situations among people who experience paranoia [ 43 ]. To better understand this possibility, future work could incorporate momentary measures of interpretation biases (ie, perceiving others as threatening) to examine the extent to which these may have decreased in the intervention.…”

Empathy, Emotion Recognition, and Paranoia in the General Population

“…Yet, as noted, social cognition is also relevant for “positive” psychotic experiences ( Bliksted et al, 2017 ; Peyroux et al, 2019 ), including paranoid thinking ( Green and Leitman, 2007 ). One robust relationship between paranoia and social cognition is via misinterpretation of social cues ( Trotta et al, 2021 ). Individuals with heightened paranoia show evidence of misinterpreting ambiguous information more negatively ( Bentall et al, 2009 ; Savulich et al, 2015 ), which may be shaped by negative prior beliefs about the intentions of others ( Wellstein et al, 2020 ).…”

“…Individuals with heightened paranoia show evidence of misinterpreting ambiguous information more negatively ( Bentall et al, 2009 ; Savulich et al, 2015 ), which may be shaped by negative prior beliefs about the intentions of others ( Wellstein et al, 2020 ). Importantly, recent meta-analysis has shown that the relationship between paranoia and misinterpretation of ambiguous cues (including emotional cues) is present in both clinical and non-clinical populations, with more severe paranoia being related to worse interpretation bias ( Trotta et al, 2021 ). This suggests that these experiences exist on a continuum across clinical and non-clinical populations.…”