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Daniel Freeman - One of the best experts on this subject based on the ideXlab platform.
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effects of cognitive behaviour therapy for worry on persecutory Delusions in patients with psychosis wit a parallel single blind randomised controlled trial with a mediation analysis
The Lancet Psychiatry, 2015Co-Authors: Daniel Freeman, Helen Startup, Graham Dunn, Katherine Pugh, Jacinta Cordwell, Helen Mander, Emma CernisAbstract:Summary Background Worry might be a contributory causal factor in the occurrence of persecutory Delusions in patients with psychotic disorders. Therefore we postulated that reducing worry with cognitive behaviour therapy (CBT) would reduce persecutory Delusions. Methods For our two-arm, assessor-blinded, randomised controlled trial (Worry Intervention Trial [WIT]), we recruited patients aged 18–65 years with persistent persecutory Delusions but non-affective psychosis from two centres: the Oxford Health National Health Service (NHS) Foundation Trust (Oxford, UK) and the Southern Health NHS Foundation Trust (Southampton, UK). The key inclusion criteria for participants were a score of at least 3 on the Psychotic Symptoms Rating Scale (PSYRATS) denoting a current persecutory Delusion; that the Delusion had persisted for at least 3 months; a clinical diagnosis of schizophrenia, schizoaffective disorder, or Delusional disorder; and a clinically significant level of worry. We randomly assigned (1:1) eligible patients, using a randomly permuted block procedure with variable block sizes and division by four strata, to either six sessions of worry-reduction CBT intervention done over 8 weeks added to standard care (the CBT-intervention group), or to standard care alone (the control group). The assessors were masked to patient allocations and did their assessments at week 0 (baseline), 8 weeks (end of treatment), and 24 weeks, follow-up. The primary outcomes were worry measured by the Penn State Worry Questionnaire (PSWQ) and Delusions measured by the PSYRATS-Delusion scale; we did the analyses in the intention-to-treat population, and also did a planned mediation analysis. This trial is registered with the ISRCTN Registry (number ISRCTN23197625) and is closed to new participants. Findings From Nov 1, 2011, to Sept 9, 2013, we recruited 150 eligible participants and randomly assigned 73 to the CBT intervention group, and 77 to the control group. 143 patients (95%) provided primary outcome follow-up data. Compared with standard care alone, at 8 weeks the CBT intervention significantly reduced worry (mean difference 6·35 [SE 1·56] PSWQ units, 95% CI 3·30–9·40; p Interpretation To our knowledge, this is the first large trial focused on persecutory Delusions. We have shown that long-standing Delusions were significantly reduced by a brief intervention targeted on worry, although the limitations for our study include no determination of the key elements within the intervention. Our results suggest that worry might cause paranoia, and that worry intervention techniques might be a beneficial addition to the standard treatment of psychosis. Funding Efficacy and Mechanism Evaluation programme, which is a UK Medical Research Council and National Institute of Health Research partnership.
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a randomized experimental investigation of reasoning training for people with Delusions
Schizophrenia Bulletin, 2011Co-Authors: Kerry Ross, Daniel Freeman, Graham Dunn, Philippa GaretyAbstract:The present study aimed to investigate whether a brief reasoning training module changes the "jumping to conclusions" data gathering bias in people with Delusions. A secondary aim was to examine whether improvements in reasoning would lead to greater flexibility in thinking about Delusions. It was found that people with Delusions and a diagnosis of schizophrenia (n = 34) requested less information on a reasoning task compared with a nonclinical control group (n = 34). The clinical group was then randomly allocated to a session of reasoning training or to an attention control condition. Following training, participants showed a significant increase in data gathering, and a small number reported more flexibility and less conviction in their Delusions, although this finding was not significant. The presence at baseline of an extreme reasoning bias moderated the effect of training. The study provides further confirmation of the jumping to conclusions bias and shows that data gathering can be improved, though the severest form of the bias is resistant to change. It is recommended that lengthier, Delusion-related reasoning packages be developed and evaluated.
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persecutory Delusions and catastrophic worry in psychosis developing the understanding of Delusion distress and persistence
Behaviour Research and Therapy, 2007Co-Authors: Helen Startup, Daniel Freeman, Philippa GaretyAbstract:Abstract In a recent theoretical account of persecutory Delusions, it is suggested that anxiety and worry are important factors in paranoid experience [Freeman, D., Garety, P. A., Kuipers, E., Fowler, D., & Bebbington, P. E. (2002). A cognitive model of persecutory Delusions. British Journal of Clinical Psychology, 41(4), 331–347]. In emotional disorders worry has been understood in terms of catastrophising. In the current study, the concept of catastrophising is applied for the first time with persecutory Delusions. Thirty individuals with current persecutory Delusions and 30 non-clinical controls participated in a cross-sectional study. The group with persecutory Delusions was also followed up at 3 months to assess predictors of Delusion persistence. At its most severe, 21% of individuals with persecutory Delusions had clinical worry, 68% had levels of worry comparable with treatment seeking GAD patients. Further, high levels of anxiety, worry and catastrophising were associated with high levels of persecutory Delusion distress and with the persistence of Delusions over 3 months. If future research replicates these findings, worry reduction interventions for individuals with persecutory Delusions may be warranted.
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grandiose Delusions an experimental investigation of the Delusion as defense
Journal of Nervous and Mental Disease, 2005Co-Authors: Nicola Smith, Daniel Freeman, Elizabeth KuipersAbstract:Two distinct roles for emotion in the development of Delusions have been outlined. Some authors argue that Delusions defend against low self-esteem and negative emotion (the Delusion-as-defense account). Other authors hypothesize that Delusions are not a defense but are a direct reflection of emotion and associated processes (the emotion-consistent account). An empirical investigation was conducted of the Delusion-as-defense account with reference to grandiose Delusions. Twenty individuals with grandiose Delusions and 21 individuals without mental illness were compared on overt and covert measures of self-esteem. No evidence for a discrepancy between overt and covert self-esteem in individuals with grandiose Delusions was found. One potential interpretation of the results is that the tasks were not able to penetrate defensive processes. However, we argue that in this group, the grandiose Delusions do not currently defend against low self-esteem. Instead, grandiose Delusions may in part be direct exaggerations of the emotional state of individuals.
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Connecting neurosis and psychosis: the direct influence of emotion on Delusions and hallucinations.
Behaviour Research and Therapy, 2003Co-Authors: Daniel Freeman, Philippa GaretyAbstract:Diagnostic classification systems contain a core divide between neurosis and psychosis, leading to their separate study and treatment. The basis for the separation of the disorders is outlined and reassessed. It is argued that the empirical evidence does not support such a sharp distinction between neurosis and psychosis. The frequent occurrence of emotional disorder prior to and accompanying psychosis indicates that neurosis contributes to the development of the positive symptoms of psychosis. Psychological theories and experimental evidence concerning the influence of emotion on the content and form of Delusions and hallucinations are therefore reviewed. It is argued that in many cases Delusions are a direct representation of emotional concerns, and that emotion contributes to Delusion formation and maintenance. The content of hallucinations less often directly expresses the emotional concerns of the individual, but emotion can trigger and contribute to the maintenance of hallucinatory phenomena, although how this occurs is not well understood. It is concluded that study needs to be made of the interaction between psychotic and neurotic processes in the development of Delusions and hallucinations, and that neurotic and psychotic disorders may have common maintenance processes.
Vaughan Bell - One of the best experts on this subject based on the ideXlab platform.
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cognitive neuropsychiatric analysis of an additional large capgras Delusion case series
Cognitive Neuropsychiatry, 2019Co-Authors: Vaughan Bell, Emily A Currell, Nomi Werbeloff, Joseph HayesAbstract:Introduction:: Although important to cognitive neuropsychiatry and theories of Delusions, Capgras Delusion has largely been reported in single case studies. Bell et al. [2017. Uncovering Capgras Delusion using a large scale medical records database. British Journal of Psychiatry Open, 3(4), 179–185] previously deployed computational and clinical case identification on a largescale medical records database to report a case series of 84 individuals with Capgras Delusion. We replicated this approach on a new database from a different mental health service provider while additionally examining instances of violence, given previous claims that Capgras is a forensic risk. Methods:: We identified 34 additional cases of Capgras. Delusion phenomenology, clinical characteristics, and presence of lesions detected by neuroimaging were extracted. Results:: Although most cases involved misidentification of family members or partners, a notable minority (20.6%) included the misidentification of others. Capgras typically did not present as a monothematic Delusion. Few cases had identifiable lesions with no evidence of right-hemisphere bias. There was no evidence of physical violence associated with Capgras. Conclusions:: Findings closely replicate Bell et al. (2017). The majority of Capgras Delusion phenomenology conforms to the “dual route” model although a significant minority of cases cannot be explained by this framework.
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internet Delusions a case series and theoretical integration
Psychopathology, 2005Co-Authors: Vaughan Bell, Ethan Grech, Cara Maiden, Peter W Halligan, Hadyn D EllisAbstract:Background: Delusions involving the internet have been reported as examples of the influence of cultural innovations on Delusion formation, although there has been some debate as to
Philippa Garety - One of the best experts on this subject based on the ideXlab platform.
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a randomized experimental investigation of reasoning training for people with Delusions
Schizophrenia Bulletin, 2011Co-Authors: Kerry Ross, Daniel Freeman, Graham Dunn, Philippa GaretyAbstract:The present study aimed to investigate whether a brief reasoning training module changes the "jumping to conclusions" data gathering bias in people with Delusions. A secondary aim was to examine whether improvements in reasoning would lead to greater flexibility in thinking about Delusions. It was found that people with Delusions and a diagnosis of schizophrenia (n = 34) requested less information on a reasoning task compared with a nonclinical control group (n = 34). The clinical group was then randomly allocated to a session of reasoning training or to an attention control condition. Following training, participants showed a significant increase in data gathering, and a small number reported more flexibility and less conviction in their Delusions, although this finding was not significant. The presence at baseline of an extreme reasoning bias moderated the effect of training. The study provides further confirmation of the jumping to conclusions bias and shows that data gathering can be improved, though the severest form of the bias is resistant to change. It is recommended that lengthier, Delusion-related reasoning packages be developed and evaluated.
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persecutory Delusions and catastrophic worry in psychosis developing the understanding of Delusion distress and persistence
Behaviour Research and Therapy, 2007Co-Authors: Helen Startup, Daniel Freeman, Philippa GaretyAbstract:Abstract In a recent theoretical account of persecutory Delusions, it is suggested that anxiety and worry are important factors in paranoid experience [Freeman, D., Garety, P. A., Kuipers, E., Fowler, D., & Bebbington, P. E. (2002). A cognitive model of persecutory Delusions. British Journal of Clinical Psychology, 41(4), 331–347]. In emotional disorders worry has been understood in terms of catastrophising. In the current study, the concept of catastrophising is applied for the first time with persecutory Delusions. Thirty individuals with current persecutory Delusions and 30 non-clinical controls participated in a cross-sectional study. The group with persecutory Delusions was also followed up at 3 months to assess predictors of Delusion persistence. At its most severe, 21% of individuals with persecutory Delusions had clinical worry, 68% had levels of worry comparable with treatment seeking GAD patients. Further, high levels of anxiety, worry and catastrophising were associated with high levels of persecutory Delusion distress and with the persistence of Delusions over 3 months. If future research replicates these findings, worry reduction interventions for individuals with persecutory Delusions may be warranted.
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Connecting neurosis and psychosis: the direct influence of emotion on Delusions and hallucinations.
Behaviour Research and Therapy, 2003Co-Authors: Daniel Freeman, Philippa GaretyAbstract:Diagnostic classification systems contain a core divide between neurosis and psychosis, leading to their separate study and treatment. The basis for the separation of the disorders is outlined and reassessed. It is argued that the empirical evidence does not support such a sharp distinction between neurosis and psychosis. The frequent occurrence of emotional disorder prior to and accompanying psychosis indicates that neurosis contributes to the development of the positive symptoms of psychosis. Psychological theories and experimental evidence concerning the influence of emotion on the content and form of Delusions and hallucinations are therefore reviewed. It is argued that in many cases Delusions are a direct representation of emotional concerns, and that emotion contributes to Delusion formation and maintenance. The content of hallucinations less often directly expresses the emotional concerns of the individual, but emotion can trigger and contribute to the maintenance of hallucinatory phenomena, although how this occurs is not well understood. It is concluded that study needs to be made of the interaction between psychotic and neurotic processes in the development of Delusions and hallucinations, and that neurotic and psychotic disorders may have common maintenance processes.
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a cognitive model of persecutory Delusions
British Journal of Clinical Psychology, 2002Co-Authors: Daniel Freeman, Philippa Garety, Elizabeth Kuipers, David Fowler, Paul BebbingtonAbstract:A multifactorial model of the formation and maintenance of persecutory Delusions is presented. Persecutory Delusions are conceptualized as threat beliefs. The beliefs are hypothesized to arise from a search for meaning for internal or external experiences that are unusual, anomalous, or emotionally significant for the individual. The persecutory explanations formed reflect an interaction between psychotic processes, pre-existing beliefs and personality (particularly emotion), and the environment. It is proposed that the Delusions are maintained by processes that lead to the receipt of confirmatory evidence and processes that prevent the processing of disconfirmatory evidence. Novel features of the model include the (non-defended) direct roles given to emotion in Delusion formation, the detailed consideration of both the content and form of Delusions, and the hypotheses concerning the associated emotional distress. The clinical and research implications of the model are outlined.
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Persecutory Delusions: developing the understanding of belief maintenance and emotional distress.
Psychological Medicine, 2001Co-Authors: Daniel Freeman, Philippa Garety, Elizabeth KuipersAbstract:Background . The objective of the study was to develop the cognitive understanding of persecutory Delusions. It was hypothesized that safety behaviours contribute to the persistence of persecutory Delusions by preventing disconfirmation. It was further hypothesized that emotional distress is associated with aspects of the content of Delusions. An investigation was designed to establish whether individuals with persecutory Delusions use safety behaviours, and to test predicted associations between Delusion content and emotional distress. Method . A cross-sectional investigation was conducted on 25 individuals with persecutory Delusions. A detailed assessment was made of the presence of safety behaviours, the content of Delusions and emotional distress. Results . All participants had used at least one safety behaviour in the last month, most typically avoidance. Higher levels of anxiety were associated with greater use of safety behaviours. New data were obtained on the content of persecutory Delusions. Aspects of the content of the Delusions were associated with levels of depression, self-esteem, anxiety and Delusional distress. Conclusions . Individuals with persecutory Delusions use safety behaviours. The findings may develop the understanding of Delusion persistence, acting upon Delusions and the negative symptoms of schizophrenia. There are implications for cognitive interventions for psychosis. Support was also found for the hypothesis that emotional distress is linked to the content of Delusional beliefs; it is speculated that prior emotional distress influences the content of Delusions, and that Delusion content in turn influences levels of emotional distress.
Helen Startup - One of the best experts on this subject based on the ideXlab platform.
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effects of cognitive behaviour therapy for worry on persecutory Delusions in patients with psychosis wit a parallel single blind randomised controlled trial with a mediation analysis
The Lancet Psychiatry, 2015Co-Authors: Daniel Freeman, Helen Startup, Graham Dunn, Katherine Pugh, Jacinta Cordwell, Helen Mander, Emma CernisAbstract:Summary Background Worry might be a contributory causal factor in the occurrence of persecutory Delusions in patients with psychotic disorders. Therefore we postulated that reducing worry with cognitive behaviour therapy (CBT) would reduce persecutory Delusions. Methods For our two-arm, assessor-blinded, randomised controlled trial (Worry Intervention Trial [WIT]), we recruited patients aged 18–65 years with persistent persecutory Delusions but non-affective psychosis from two centres: the Oxford Health National Health Service (NHS) Foundation Trust (Oxford, UK) and the Southern Health NHS Foundation Trust (Southampton, UK). The key inclusion criteria for participants were a score of at least 3 on the Psychotic Symptoms Rating Scale (PSYRATS) denoting a current persecutory Delusion; that the Delusion had persisted for at least 3 months; a clinical diagnosis of schizophrenia, schizoaffective disorder, or Delusional disorder; and a clinically significant level of worry. We randomly assigned (1:1) eligible patients, using a randomly permuted block procedure with variable block sizes and division by four strata, to either six sessions of worry-reduction CBT intervention done over 8 weeks added to standard care (the CBT-intervention group), or to standard care alone (the control group). The assessors were masked to patient allocations and did their assessments at week 0 (baseline), 8 weeks (end of treatment), and 24 weeks, follow-up. The primary outcomes were worry measured by the Penn State Worry Questionnaire (PSWQ) and Delusions measured by the PSYRATS-Delusion scale; we did the analyses in the intention-to-treat population, and also did a planned mediation analysis. This trial is registered with the ISRCTN Registry (number ISRCTN23197625) and is closed to new participants. Findings From Nov 1, 2011, to Sept 9, 2013, we recruited 150 eligible participants and randomly assigned 73 to the CBT intervention group, and 77 to the control group. 143 patients (95%) provided primary outcome follow-up data. Compared with standard care alone, at 8 weeks the CBT intervention significantly reduced worry (mean difference 6·35 [SE 1·56] PSWQ units, 95% CI 3·30–9·40; p Interpretation To our knowledge, this is the first large trial focused on persecutory Delusions. We have shown that long-standing Delusions were significantly reduced by a brief intervention targeted on worry, although the limitations for our study include no determination of the key elements within the intervention. Our results suggest that worry might cause paranoia, and that worry intervention techniques might be a beneficial addition to the standard treatment of psychosis. Funding Efficacy and Mechanism Evaluation programme, which is a UK Medical Research Council and National Institute of Health Research partnership.
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persecutory Delusions and catastrophic worry in psychosis developing the understanding of Delusion distress and persistence
Behaviour Research and Therapy, 2007Co-Authors: Helen Startup, Daniel Freeman, Philippa GaretyAbstract:Abstract In a recent theoretical account of persecutory Delusions, it is suggested that anxiety and worry are important factors in paranoid experience [Freeman, D., Garety, P. A., Kuipers, E., Fowler, D., & Bebbington, P. E. (2002). A cognitive model of persecutory Delusions. British Journal of Clinical Psychology, 41(4), 331–347]. In emotional disorders worry has been understood in terms of catastrophising. In the current study, the concept of catastrophising is applied for the first time with persecutory Delusions. Thirty individuals with current persecutory Delusions and 30 non-clinical controls participated in a cross-sectional study. The group with persecutory Delusions was also followed up at 3 months to assess predictors of Delusion persistence. At its most severe, 21% of individuals with persecutory Delusions had clinical worry, 68% had levels of worry comparable with treatment seeking GAD patients. Further, high levels of anxiety, worry and catastrophising were associated with high levels of persecutory Delusion distress and with the persistence of Delusions over 3 months. If future research replicates these findings, worry reduction interventions for individuals with persecutory Delusions may be warranted.
Robyn Langdon - One of the best experts on this subject based on the ideXlab platform.
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Delusion and confabulation: Mistakes of perceiving, remembering and believing
Cognitive Neuropsychiatry, 2017Co-Authors: Robyn Langdon, Tim BayneAbstract:This paper adopts an inclusive approach to the relationship between Delusion and confabulation, according to which some symptoms might qualify as both Delusional and confabulatory. Our initial focus is on the cardinal signs of Delusions: incomprehensibility, incorrigibility, and subjective conviction. Setting aside post hoc (or secondary) confabulations-plausible rationalisations that might be generated by nonpathological belief formation processes-we focus on spontaneous memory-based confabulations which, we suggest, conform to the characterisation of Delusions. After considering current accounts of the role of experience in Delusion formation, we propose that spontaneous confabulations are located at (or towards) the "received" end of a "received-reflective" spectrum of Delusions: the spontaneous confabulator simply receives and endorses as genuine the content of an apparent-yet implausible-memory experience. Underlying both spontaneous confabulations and other received Delusions, we propose, is an inability to inhibit the prepotent tendency to upload and maintain experiential content (mnemonic or perceptual) into belief.
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modeling erotomania Delusion in the laboratory with hypnosis
International Journal of Clinical and Experimental Hypnosis, 2012Co-Authors: Jillian E Attewell, Rochelle E Cox, Amanda J Barnier, Robyn LangdonAbstract:Erotomania is the Delusional belief that one is loved from afar by another person (the target). This study used hypnosis as a novel cognitive neuropsychological research tool to model erotomania. The authors developed 2 versions of a hypnotic erotomania suggestion and tested their impact by asking subjects to recall and interpret a story featuring ambiguous scenarios. They also challenged the Delusion by asking subjects to justify their beliefs. The hypnotic erotomania suggestions successfully recreated the features of the clinical Delusion for many high hypnotizable subjects. They believed that the target loved them, interpreted ambiguous information consistent with this belief and confabulated evidence in service of their Delusion. Some also resisted all challenges to their Delusion. These features are strikingly similar to clinical cases and highlight the value of using hypnosis to model clinical Delusions. The authors also discuss some limitations of this approach.
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Delusion and confabulation a special issue of cognitive neuropsychiatry
2010Co-Authors: Robyn Langdon, Martha TurnerAbstract:R. Langdon, M. Turner, Delusion and Confabulation: Overlapping or Distinct Distortions of Reality? M.D. Kopelman, Varieties of Confabulation and Delusion. A. Fotopoulou, The Affective Neuropsychology of Confabulation and Delusion. K. Metcalf, R. Langdon, M. Coltheart, The Role of Personal Biases in the Explanation of Confabulation. G. Dalla Barba, M.F. Boisse, Temporal Consciousness and Confabulation: Is the Medial Temporal Lobe "Temporal"? A.R. O'Connor, C. Lever, C.J.A. Moulin, Novel Insights into False Recollection: A Model of Deja Vecu. A. Gilboa, Strategic Retrieval, Confabulations and Delusions: Theory and Data. V.J. Carr, Beauty and Belief: William James and the Aesthetics of Delusions in Schizophrenia. R.E. Cox, A.J. Barnier, Hypnotic Illusions and Clinical Delusions: Hypnosis as a Research Method. W. Hirstein, The Misidentification Syndromes as Mindreading Disorders. M. Coltheart, P. Menzies, J. Sutton, Abductive Inference and Delusional Belief. R. McKay, M. Kinsbourne, Motivational Factors and False Claims. R. Langdon, T. Bayne, Delusion and Confabulation: Mistakes of Perceiving, Remembering and Believing. M. Turner, M. Coltheart, Confabulation and Delusion: A Common Monitoring Framework?
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developing hypnotic analogues of clinical Delusions mirrored self misidentification
Cognitive Neuropsychiatry, 2008Co-Authors: Amanda J Barnier, Robyn Langdon, Max Coltheart, Rochelle E Cox, Akira R Oconnor, Nora Breen, Martha TurnerAbstract:Introduction. Despite current research interest in Delusional beliefs, there are no viable models for studying Delusions in the laboratory. However, hypnosis offers a technique for creating transient Delusions that are resistant to challenge. The aim of this study was to develop an hypnotic analogue of one important Delusion, mirrored-self misidentification. Methods. Twelve high hypnotisable participants received an hypnotic suggestion to see either a stranger in the mirror, a mirror as a window, or a mirror as a window with a view to a stranger. Participants’ deluded beliefs were challenged, and following hypnosis, Sheehan and McConkey's (1982) Experiential Analysis Technique was used to explore participants’ phenomenological experience of the Delusion. Results. The majority of participants did not recognise their reflection in the mirror, described the person in the mirror as having different physical characteristics to themselves, and maintained their Delusion when challenged. Conclusions. The hypnotic...
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models of misbelief integrating motivational and deficit theories of Delusions
Consciousness and Cognition, 2007Co-Authors: Robyn Langdon, Ryan Mckay, Max ColtheartAbstract:The impact of our desires and preferences upon our ordinary, everyday beliefs is well-documented [Gilovich, T. (1991). How we know what isn't so: The fallibility of human reason in everyday life. New York: The Free Press.]. The influence of such motivational factors on Delusions, which are instances of pathological misbelief, has tended however to be neglected by certain prevailing models of Delusion formation and maintenance. This paper explores a distinction between two general classes of theoretical explanation for Delusions; the motivational and the deficit. Motivational approaches view Delusions as extreme instances of self-deception; as defensive attempts to relieve pain and distress. Deficit approaches, in contrast, view Delusions as the consequence of defects in the normal functioning of belief mechanisms, underpinned by neuroanatomical or neurophysiological abnormalities. It is argued that although there are good reasons to be sceptical of motivational theories (particularly in their more floridly psychodynamic manifestations), recent experiments confirm that motives are important causal forces where Delusions are concerned. It is therefore concluded that the most comprehensive account of Delusions will involve a theoretical unification of both motivational and deficit approaches.