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

Abstract

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.

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

“…Patients with the "poor me" condition, however, perceive themselves as undeserved victims of malevolent others (Chadwick, Trower, Juusti-Butler, & Maguire, 2005;Trower & Chadwick, 1995). It is discussed in the current literature that transition from the at-risk state to psychosis is associated with a shift from "bad me" to "poor me" paranoia (Morrison et al, 2015).…”

The role of cognitive and metacognitive factors in non‐clinical paranoia and negative affect

“…Analyses were conducted using Mplus version 7.31 (Muth en & Muth en, 1998-2015, a latent variable modelling package. We used structural equation models (SEMs) to test the hypotheses, as it allows the assessment of multiple pathways indicating direct and indirect effects, and allows for the simultaneous assessment of the multiple hypotheses.…”

“…In the current psychological literature, there is limited research concerning how cognitive and metacognitive variables differentially or jointly influence paranoia. One previous study has investigated the combined role of cognitive and metacognitive factors in relation to paranoia in people at risk of psychosis (Morrison et al ., ). The findings supported several hypotheses of both cognitive and metacognitive models.…”

“…Specifically, this is the first study to test both metacognitive beliefs and schemas as potential moderators of the relationship between paranoia and negative affect in a large non‐clinical sample. First, a baseline model will test the hypothesis that paranoia predicts negative affect as suggested by previous research (Fowler et al ., ; Morrison et al ., ). Second, the moderating effect of both metacognitive beliefs and schemas will be examined as these are both highlighted as potential factors related to non‐clinical paranoia (Fowler et al ., ; Morrison et al ., ).…”

Relationship between metacognitive beliefs and psychosocial performance in at‐risk states of psychosis and patients with first psychotic episodes

“…Furthermore, impaired metacognitive capacity is correlated with negative symptoms, insight and neurocognitive deficits in schizophrenia (Lysaker et al, 2005;Nicolò et al, 2012). With regard to the latter, other studies have revealed that metacognitive deficits are highly correlated with paranoid ideation and hallucinations in patients with psychosis (Morrison & Wells, 2003;Morrison et al, 2015). Moreover, metacognitive beliefs may be associated with subjective distress in relation to the experience of auditory hallucinations in clinical and non-clinical individuals (Hill, Varese, Jackson, & Linden, 2012), which renders metacognition an interesting cognitive candidate for further exploration in people with at-risk mental states of psychosis (ARMS).…”