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Daniel Freeman - One of the best experts on this subject based on the ideXlab platform.

  • Digitally supported CBT to reduce Paranoia and improve reasoning for people with schizophrenia-spectrum psychosis: the SlowMo RCT
    'National Institute for Health Research', 2021
    Co-Authors: Philippa Garety, Graham Dunn, Daniel Freeman, Paul Bebbington, David Fowler, Elizabeth Kuipers, Richard Emsley, Thomas Ward, Kathryn Greenwood, Amy Hardy
    Abstract:

    Background: Reasoning may play a causal role in paranoid delusions in psychosis. SlowMo, a new digitally supported cognitive–behavioural therapy, targets reasoning to reduce Paranoia. Objectives: To examine the effectiveness of SlowMo therapy in reducing Paranoia and in improving reasoning, quality of life and well-being, and to examine its mechanisms of action, moderators of effects and acceptability. Design: A parallel-arm, assessor-blind, randomised controlled trial comparing SlowMo plus treatment as usual with treatment as usual alone. An online independent system randomised eligible participants (1 : 1) using randomly varying permuted blocks, stratified by site and Paranoia severity. Setting: Community mental health services in three NHS mental health trusts in England, plus patient identification centres. Participants: A total of 362 participants with schizophrenia-spectrum psychosis. Eligibility criteria comprised distressing and persistent (≥ 3 months) Paranoia. Interventions: Eight face-to-face SlowMo sessions over 12 weeks plus treatment as usual, or treatment as usual alone (control group). Main outcome measures: The primary outcome measure was Paranoia measured by the Green Paranoid Thoughts Scale and its revised version, together with observer-rated measures of persecutory delusions (The Psychotic Symptom Rating Scales delusion scale and delusion items from the Scale for the Assessment of Positive Symptoms). The secondary outcome measures were reasoning (measures of belief flexibility, jumping to conclusions, and fast and slow thinking), well-being, quality of life, schemas, service use and worry. Results: A total of 362 participants were recruited between 1 May 2017 and 14 May 2019: 181 in the SlowMo intervention group and 181 in the treatment-as-usual (control) group. One control participant subsequently withdrew. In total, 325 (90%) participants provided primary Green Paranoid Thoughts Scale outcome data at 12 weeks (SlowMo, n = 162; treatment as usual, n = 163). A total of 145 (80%) participants in the SlowMo group completed all eight therapy sessions. SlowMo was superior to treatment as usual in reducing Paranoia on all three measures used: Green Paranoid Thoughts Scale total at 12 weeks (Cohen’s d = 0.30, 95% confidence interval 0.09 to 0.51; p = 0.005) and 24 weeks (Cohen’s d = 0.20, 95% confidence interval –0.02 to 0.40; p = 0.063); Psychotic Symptom Rating Scales delusions at 12 weeks (Cohen’s d = 0.47, 95% confidence interval 0.17 to 0.78; p = 0.002) and 24 weeks (Cohen’s d = 0.50, 95% confidence interval 0.20 to 0.80; p = 0.001); and Scale for the Assessment of Positive Symptoms persecutory delusions at 12 weeks (Cohen’s d = 0.43, 95% confidence interval 0.03 to 0.84; p = 0.035) and 24 weeks (Cohen’s d = 0.54, 95% confidence interval 0.14 to 0.94; p = 0.009). Reasoning (belief flexibility, possibility of being mistaken and Fast and Slow Thinking Questionnaire measure) improved, but jumping to conclusions did not improve. Worry, quality of life, well-being and self-concept also improved, improving most strongly at 24 weeks. Baseline characteristics did not moderate treatment effects. Changes in belief flexibility and worry mediated changes in Paranoia. Peer researcher-led qualitative interviews confirmed positive experiences of the therapy and technology. Nineteen participants in the SlowMo group and 21 participants in the treatment-as-usual group reported 54 adverse events (51 serious events, no deaths). Limitations: The trial included treatment as usual as the comparator and, thus, the trial design did not control for the effects of time with a therapist. Conclusions: To the best of our knowledge, this is the largest trial of a psychological therapy for Paranoia in people with psychosis and the first trial using a brief targeted digitally supported therapy. High rates of therapy uptake demonstrated acceptability. It was effective for Paranoia, comparable to longer therapy, and equally effective for people with different levels of negative symptoms and working memory. Mediators were improvements in belief flexibility and worry. Our results suggest that targeting reasoning helps Paranoia. Future work: Further examination of SlowMo mechanisms of action and implementation. Trial registration: Current Controlled Trials ISRCTN32448671. Funding: This project was funded by the Efficacy and Mechanism Evaluation (EME) programme, a MRC and National Institute for Health Research (NIHR) partnership. This will be published in full in Efficacy and Mechanism Evaluation; Vol. 8, No. 11. See the NIHR Journals Library website for further project information

  • adolescent Paranoia prevalence structure and causal mechanisms
    Schizophrenia Bulletin, 2019
    Co-Authors: Daniel Freeman, Jessica C Bird, R J Evans, Felicity Waite, Bao Sheng Loe
    Abstract:

    Background Adolescence can be a challenging time, characterized by self-consciousness, heightened regard for peer acceptance, and fear of rejection. Interpersonal concerns are amplified by unpredictable social interactions, both online and offline. This developmental and social context is potentially conducive to the emergence of Paranoia. However, research on Paranoia during adolescence is scarce. Method Our aim was to examine the prevalence, structure, and probabilistic causal mechanisms of adolescent Paranoia. A representative school cohort of 801 adolescents (11-15 y) completed measures of Paranoia and a range of affective, cognitive, and social factors. A Bayesian approach with Directed Acyclic Graphs (DAGs) was used to assess the causal interactions with Paranoia. Results Paranoid thoughts were very common, followed a continuous distribution, and were hierarchically structured. There was an overall Paranoia factor, with sub-factors of social fears, physical threat fears, and conspiracy concerns. With all other variables controlled, DAG analysis identified Paranoia had dependent relationships with negative affect, peer difficulties, bullying, and cognitive-affective responses to social media. The causal directions could not be fully determined, but it was more likely that negative affect contributed to Paranoia and Paranoia impacted peer relationships. Problematic social media use did not causally influence Paranoia. Conclusions There is a continuum of Paranoia in adolescence and occasional suspicions are common at this age. Anxiety and depression are closely connected with Paranoia and may causally contribute to its development. Paranoia may negatively impact adolescent peer relationships. The clinical significance of Paranoia in adolescents accessing mental health services must now be established.

  • the effects of cannabidiol on persecutory ideation and anxiety in a high trait paranoid group
    Journal of Psychopharmacology, 2018
    Co-Authors: Harneet Hundal, Angus Antley, Daniel Freeman, Rachel Lister, Nicole Evans, Amir Englund, Robin M Murray, Paul D Morrison
    Abstract:

    Background:Previous studies have suggested that cannabidiol has anxiolytic and antipsychotic properties, raising hopes that cannabidiol will translate to the psychiatric clinic. Cannabidiol may be particularly useful for anxiety and Paranoia in those at-risk of major mental illness.Methods:Immersion in a controlled 3D virtual-reality scenario was used to assay persecutory ideation and anxiety in a sample of non-clinical volunteers (n=32) pre-selected for high paranoid traits. Participants were randomised to receive oral cannabidiol (600 mg) or placebo 130 min prior to entering virtual-reality. Well-validated rating scales were used to assay persecutory thinking and anxiety. Salivary cortisol concentration, heart rate and blood pressure were measured over the course of the experimental session.Results:Immersion in the virtual-reality session elicited anxiety as indexed by the Beck’s anxiety inventory (p<0.005), and increased cortisol concentration (p=0.05), heart rate (p<0.05) and systolic blood pressure (...

  • a shared genetic propensity underlies experiences of bullying victimization in late childhood and self rated paranoid thinking in adolescence
    Schizophrenia Bulletin, 2015
    Co-Authors: Sania Shakoor, Daniel Freeman, P Mcguire, Alastair G Cardno, Robert Plomin, Angelica Ronald
    Abstract:

    Background: Bullying is a risk factor for developing psychotic experiences (PEs). Whether bullying is associated with particular PEs, and the extent to which genes and environments influence the association, are unknown. This study investigated which specific PEs in adolescence are associated with earlier bullying victimization and the genetic and environmental contributions underlying their association. Method: Participants were 4826 twin pairs from a longitudinal community-based twin study in England and Wales who reported on their bullying victimization at the age of 12 years. Measures of specific PEs (self-rated Paranoia, Hallucinations, Cognitive disorganization, Grandiosity, Anhedonia, and parent-rated Negative Symptoms) were recorded at age of 16 years. Results: Childhood bullying victimization was most strongly associated with Paranoia in adolescence (r = .26; P < .01), with weaker associations with Hallucinations, Cognitive Disorganization, parent-rated Negative Symptoms (r = .12–.20; P < .01), Grandiosity (r = .04; P < .05), and Anhedonia (r = .00, n.s.). Bivariate twin model-fitting demonstrated that bullying victimization and Paranoia were both heritable (35% and 52%, respectively) with unique environmental influences (39% and 48%, respectively), and bullying victimization showed common environmental influences (26%). The association between bullying victimization and Paranoia operated almost entirely via genetic influences (bivariate heritability = 93%), with considerable genetic overlap (genetic correlation = .55). Conclusion: In contrast to the assumed role of bullying victimization as an environmental trigger, these data suggest that bullying victimization in late childhood is particularly linked to self-rated Paranoia in adolescence via a shared genetic propensity. Clinically, individuals with a history of bullying victimization are predicted to be particularly susceptible to paranoid symptoms.

  • how cannabis causes Paranoia using the intravenous administration of 9 tetrahydrocannabinol thc to identify key cognitive mechanisms leading to Paranoia
    Schizophrenia Bulletin, 2015
    Co-Authors: Daniel Freeman, Angus Antley, Mel Slater, Graham Dunn, Rachel Lister, Nicole Evans, Robin M Murray, B Godlewska, Robert Cornish
    Abstract:

    Paranoia is receiving increasing attention in its own right, since it is a central experience of psychotic disorders and a marker of the health of a society. Paranoia is associated with use of the most commonly taken illicit drug, cannabis. The objective was to determine whether the principal psychoactive ingredient of cannabis—∆9-tetrahydrocannabinol (THC)—causes Paranoia and to use the drug as a probe to identify key cognitive mechanisms underlying Paranoia. A randomized, placebo-controlled, between-groups test of the effects of intravenous THC was conducted. A total of 121 individuals with paranoid ideation were randomized to receive placebo, THC, or THC preceded by a cognitive awareness condition. Paranoia was assessed extensively via a real social situation, an immersive virtual reality experiment, and standard self-report and interviewer measures. Putative causal factors were assessed. Principal components analysis was used to create a composite Paranoia score and composite causal variables to be tested in a mediation analysis. THC significantly increased Paranoia, negative affect (anxiety, worry, depression, negative thoughts about the self), and a range of anomalous experiences, and reduced working memory capacity. The increase in negative affect and in anomalous experiences fully accounted for the increase in Paranoia. Working memory changes did not lead to Paranoia. Making participants aware of the effects of THC had little impact. In this largest study of intravenous THC, it was definitively demonstrated that the drug triggers paranoid thoughts in vulnerable individuals. The most likely mechanism of action causing Paranoia was the generation of negative affect and anomalous experiences.

Richard P Bentall - One of the best experts on this subject based on the ideXlab platform.

  • sexual minority status and symptoms of psychosis the role of bullying discrimination social support and drug use findings from the adult psychiatric morbidity survey 2007
    Psychology and Psychotherapy-theory Research and Practice, 2020
    Co-Authors: Jasper Palmierclaus, Filippo Varese, Juliette Simpson, Richard P Bentall
    Abstract:

    Objective Sexual minorities have an increased risk of psychosis, potentially explained by experiences of social adversity. Sexual minorities may also have a specific risk of paranoid symptoms. The current study aimed to determine whether sexual minorities have increased risk of psychosis, whether they have a specific increased risk of Paranoia when compared to auditory verbal hallucinations (AVHs), and whether social adversity such as bullying, recent discrimination, lack of social support, and drug use can explain this risk. Methods The study used data from the Adult Psychiatric Morbidity Survey 2007 (n = 7,403), exploring both sexual identity and past sexual behaviour. Associations between sexual minority status and probable psychosis, Paranoia, and AVH were analysed using logistic regression. Mediation analysis was also conducted using the Karlson-Holm-Breen method, with bullying, recent discrimination, social support, and drug use as mediators assessing pathways between sexual minority status and Paranoia/AVH. Socio-demographic confounders were included in analyses. Results Sexual minority status did not significantly predict probable psychosis. Findings generally indicated a specific association between sexual minority status and Paranoia when contrasted with AVH. However, sexual behaviour remained significantly associated with AVH in logistic regression models. Bullying, lack of social support, and drug use partially mediated the association between sexual minority status and Paranoia. Conclusions Sexual minority status appears to have a specific association with Paranoia symptoms, which may be partially explained by experiences of social adversity. However, the cross-sectional nature of the study limits direct inference about causality of such symptoms. Practitioner points Sexual minority groups may be more likely to experience symptoms of Paranoia. It may be important to consider experiences of social adversity such as bullying, lack of social support, and also history of drug use in the context of Paranoia within these groups.

  • insecure attachment is associated with Paranoia but not hallucinations in psychotic patients the mediating role of negative self esteem
    Psychological Medicine, 2015
    Co-Authors: Sophie Wickham, Katarzyna Sitko, Richard P Bentall
    Abstract:

    Background A growing body of research has investigated associations between insecure attachment styles and psychosis. However, despite good theoretical and epidemiological reasons for hypothesising that insecure attachment may be specifically implicated in paranoid delusions, few studies have considered the role it plays in specific symptoms. Method We examined the relationship between attachment style, paranoid beliefs and hallucinatory experiences in a sample of 176 people with a diagnosis of schizophrenia spectrum disorders and 113 healthy controls. We also investigated the possible role of negative self-esteem in mediating this association. Results Insecure attachment predicted Paranoia but not hallucinations after co-morbidity between the symptoms was controlled for. Negative self-esteem partially mediated the association between attachment anxiety and clinical Paranoia, and fully mediated the relationship between attachment avoidance and clinical Paranoia. Conclusions It may be fruitful to explore attachment representations in psychological treatments for paranoid patients. If future research confirms the importance of disrupted attachment as a risk factor for persecutory delusions, consideration might be given to how to protect vulnerable young people, for example those raised in children's homes.

  • do specific early life adversities lead to specific symptoms of psychosis a study from the 2007 the adult psychiatric morbidity survey
    Schizophrenia Bulletin, 2012
    Co-Authors: Richard P Bentall, Sophie Wickham, Mark Shevlin, Filippo Varese
    Abstract:

    Previous studies have reported associations between childhood adversities, eg, loss of a parent, being raised in institutional care, sexual and other kinds of abuse by adults and bullying by peers, and psychosis in adulthood. However, the mechanisms by which these adversities lead to psychotic experiences are poorly understood. From models of the psychological processes involved in positive symptoms, it was predicted that childhood sexual abuse would be specifically associated with auditory hallucinations in adulthood, and that disruption of early attachment relations and more chronic forms of victimization such as bullying would be specifically associated with paranoid ideation. We therefore examined the associations between sexual trauma, physical abuse, bullying, and being brought up in institutional or local authority care and reports of auditory hallucinations and paranoid beliefs in the 2007 Adult Psychiatric Morbidity Survey. All simple associations between childhood adversities and the two symptom types were significant. Childhood rape was associated only with hallucinations (OR 8.9, CI = 1.86–42.44) once co-occurring Paranoia was controlled for. Being brought up in institutional care (OR = 11.08, CI = 3.26–37.62) was specifically associated with Paranoia once comorbid hallucinations had been controlled for. For each symptom, dose-response relationships were observed between the number of childhood traumas and the risk of the symptom. The specific associations observed are consistent with current psychological theories about the origins of hallucinations and Paranoia. Further research is required to study the psychological and biological mediators of these associations.

  • dissociative and metacognitive factors in hallucination proneness when controlling for comorbid symptoms
    Cognitive Neuropsychiatry, 2011
    Co-Authors: Filippo Varese, Emma Barkus, Richard P Bentall
    Abstract:

    Introduction. Recent studies have linked hallucination-proneness to dysfunctional metacognitive beliefs, dissociation, and disrupted capacity to discriminate between internal and external cognitive events (reality discrimination). This study addressed a number of methodological limitations of previous research by investigating the relationship between hallucination-proneness and the aforementioned variables while controlling for comorbid symptoms. Method. A large sample of nonclinical participants was screened on measures of hallucination-proneness, cognitive intrusions, paranoid ideation, metacognitive beliefs, and dispositional mindfulness (including measures of dissociation-like experiences). In addition, a signal detection task was used to investigate reality discrimination in four subgroups of participants selected on the basis of their scores on hallucination-proneness and intrusions. Results. Regression analyses for the self-report data were conducted to investigate the predictors of hallucination-proneness and Paranoia when controlling for comorbid symptoms. Also, between-group differences on the behavioural data were tested to determine whether perturbed reality discrimination is specifically associated with hallucination-proneness rather than cognitive intrusions. Results revealed that metacognitive beliefs are more strongly associated with intrusions and Paranoia than hallucination-proneness, whereas hallucination-proneness is related to perturbed reality discrimination and dissociation. Conclusions. These results clarify previous research on metacognitive dysfunction in hallucination-proneness, and highlight the importance of controlling for the covariation among symptoms when investigating the cognitive processes underlying psychotic experiences.

  • the cognitive and affective structure of paranoid delusions a transdiagnostic investigation of patients with schizophrenia spectrum disorders and depression
    Archives of General Psychiatry, 2009
    Co-Authors: Richard P Bentall, Georgina Rowse, Rosie Moore, Nigel Blackwood, Robert Howard, Peter Kinderman, Nick Shryane, Rhiannon Corcoran
    Abstract:

    CONTEXT: Paranoid delusions are a common symptom of a range of psychotic disorders. A variety of psychological mechanisms have been implicated in their cause, including a tendency to jump to conclusions, an impairment in the ability to understand the mental states of other people (theory of mind), an abnormal anticipation of threat, and an abnormal explanatory style coupled with low self-esteem. OBJECTIVE: To determine the structure of the relationships among psychological mechanisms contributing to Paranoia in a transdiagnostic sample. DESIGN: Cross-sectional design, with relationships between predictor variables and Paranoia examined by structural equation models with latent variables. SETTING: Publicly funded psychiatric services in London and the North West of England. PARTICIPANTS: One hundred seventy-three patients with schizophrenia spectrum disorders, major depression, or late-onset schizophrenia-like psychosis, subdivided according to whether they were currently experiencing paranoid delusions. Sixty-four healthy control participants matched for appropriate demographic variables were included. MAIN OUTCOME MEASURES: Assessments of theory of mind, jumping to conclusions bias, and general intellectual functioning, with measures of threat anticipation, emotion, self-esteem, and explanatory style. RESULTS: The best fitting (chi(2)(96) = 131.69, P = .01; comparative fit index = 0.95; Tucker-Lewis Index = 0.96; root-mean-square error of approximation = 0.04) and most parsimonious model of the data indicated that paranoid delusions are associated with a combination of pessimistic thinking style (low self-esteem, pessimistic explanatory style, and negative emotion) and impaired cognitive performance (executive functioning, tendency to jump to conclusions, and ability to reason about the mental states of others). Pessimistic thinking correlated highly with Paranoia even when controlling for cognitive performance (r = 0.65, P < .001), and cognitive performance correlated with Paranoia when controlling for pessimism (r = -0.34, P < .001). CONCLUSIONS: Both cognitive and emotion-related processes are involved in paranoid delusions. Treatment for paranoid patients should address both types of processes.

Philippa Garety - One of the best experts on this subject based on the ideXlab platform.

  • Digitally supported CBT to reduce Paranoia and improve reasoning for people with schizophrenia-spectrum psychosis: the SlowMo RCT
    'National Institute for Health Research', 2021
    Co-Authors: Philippa Garety, Graham Dunn, Daniel Freeman, Paul Bebbington, David Fowler, Elizabeth Kuipers, Richard Emsley, Thomas Ward, Kathryn Greenwood, Amy Hardy
    Abstract:

    Background: Reasoning may play a causal role in paranoid delusions in psychosis. SlowMo, a new digitally supported cognitive–behavioural therapy, targets reasoning to reduce Paranoia. Objectives: To examine the effectiveness of SlowMo therapy in reducing Paranoia and in improving reasoning, quality of life and well-being, and to examine its mechanisms of action, moderators of effects and acceptability. Design: A parallel-arm, assessor-blind, randomised controlled trial comparing SlowMo plus treatment as usual with treatment as usual alone. An online independent system randomised eligible participants (1 : 1) using randomly varying permuted blocks, stratified by site and Paranoia severity. Setting: Community mental health services in three NHS mental health trusts in England, plus patient identification centres. Participants: A total of 362 participants with schizophrenia-spectrum psychosis. Eligibility criteria comprised distressing and persistent (≥ 3 months) Paranoia. Interventions: Eight face-to-face SlowMo sessions over 12 weeks plus treatment as usual, or treatment as usual alone (control group). Main outcome measures: The primary outcome measure was Paranoia measured by the Green Paranoid Thoughts Scale and its revised version, together with observer-rated measures of persecutory delusions (The Psychotic Symptom Rating Scales delusion scale and delusion items from the Scale for the Assessment of Positive Symptoms). The secondary outcome measures were reasoning (measures of belief flexibility, jumping to conclusions, and fast and slow thinking), well-being, quality of life, schemas, service use and worry. Results: A total of 362 participants were recruited between 1 May 2017 and 14 May 2019: 181 in the SlowMo intervention group and 181 in the treatment-as-usual (control) group. One control participant subsequently withdrew. In total, 325 (90%) participants provided primary Green Paranoid Thoughts Scale outcome data at 12 weeks (SlowMo, n = 162; treatment as usual, n = 163). A total of 145 (80%) participants in the SlowMo group completed all eight therapy sessions. SlowMo was superior to treatment as usual in reducing Paranoia on all three measures used: Green Paranoid Thoughts Scale total at 12 weeks (Cohen’s d = 0.30, 95% confidence interval 0.09 to 0.51; p = 0.005) and 24 weeks (Cohen’s d = 0.20, 95% confidence interval –0.02 to 0.40; p = 0.063); Psychotic Symptom Rating Scales delusions at 12 weeks (Cohen’s d = 0.47, 95% confidence interval 0.17 to 0.78; p = 0.002) and 24 weeks (Cohen’s d = 0.50, 95% confidence interval 0.20 to 0.80; p = 0.001); and Scale for the Assessment of Positive Symptoms persecutory delusions at 12 weeks (Cohen’s d = 0.43, 95% confidence interval 0.03 to 0.84; p = 0.035) and 24 weeks (Cohen’s d = 0.54, 95% confidence interval 0.14 to 0.94; p = 0.009). Reasoning (belief flexibility, possibility of being mistaken and Fast and Slow Thinking Questionnaire measure) improved, but jumping to conclusions did not improve. Worry, quality of life, well-being and self-concept also improved, improving most strongly at 24 weeks. Baseline characteristics did not moderate treatment effects. Changes in belief flexibility and worry mediated changes in Paranoia. Peer researcher-led qualitative interviews confirmed positive experiences of the therapy and technology. Nineteen participants in the SlowMo group and 21 participants in the treatment-as-usual group reported 54 adverse events (51 serious events, no deaths). Limitations: The trial included treatment as usual as the comparator and, thus, the trial design did not control for the effects of time with a therapist. Conclusions: To the best of our knowledge, this is the largest trial of a psychological therapy for Paranoia in people with psychosis and the first trial using a brief targeted digitally supported therapy. High rates of therapy uptake demonstrated acceptability. It was effective for Paranoia, comparable to longer therapy, and equally effective for people with different levels of negative symptoms and working memory. Mediators were improvements in belief flexibility and worry. Our results suggest that targeting reasoning helps Paranoia. Future work: Further examination of SlowMo mechanisms of action and implementation. Trial registration: Current Controlled Trials ISRCTN32448671. Funding: This project was funded by the Efficacy and Mechanism Evaluation (EME) programme, a MRC and National Institute for Health Research (NIHR) partnership. This will be published in full in Efficacy and Mechanism Evaluation; Vol. 8, No. 11. See the NIHR Journals Library website for further project information

  • current paranoid thinking in patients with delusions the presence of cognitive affective biases
    Schizophrenia Bulletin, 2013
    Co-Authors: Daniel Freeman, Graham Dunn, Philippa Garety, Paul Bebbington, David Fowler, Elizabeth Kuipers, Richard Emsley, Suzanne Jolley
    Abstract:

    Background: There has been renewed interest in the influence of affect on psychosis. Psychological research on persecutory delusions ascribes a prominent role to cognitive processes related to negative affect: anxiety leads to the anticipation of threat within Paranoia; depressive negative ideas about the self create a sense of vulnerability in which paranoid thoughts flourish; and self-consciousness enhances feelings of the self as a target. The objective of this study was to examine such affective processes in relation to state Paranoia in patients with delusions. Methods: 130 patients with delusions in the context of a nonaffective psychosis diagnosis (predominately schizophrenia) were assessed for contemporaneous levels of persecutory ideation on 5 visual analog scales. Measures were taken of anxiety, depression, threat anticipation, interpretation of ambiguity, self-focus, and negative ideas about the self. Results: Of the patients, 85% report paranoid thinking at testing. Symptoms of anxiety and depression were highly prevalent. Current paranoid thinking was associated with anxiety, depression, greater anticipation of threat events, negative interpretations of ambiguous events, a self-focused cognitive style, and negative ideas about the self. Conclusions: The study provides a clear demonstration that a range of emotion-related cognitive biases, each of which could plausibly maintain delusions, are associated with current paranoid thinking in patients with psychosis. We identified biases both in the contents of cognition and in the processing of information. Links between affect and psychosis are central to the understanding of schizophrenia. We conclude that treatment of emotional dysfunction should lead to reductions in current psychotic experiences.

  • negative cognition depressed mood and Paranoia a longitudinal pathway analysis using structural equation modeling
    Schizophrenia Bulletin, 2012
    Co-Authors: David Fowler, Graham Dunn, Daniel Freeman, Philippa Garety, Elizabeth Kuipers, Joanne Hodgekins, Ben Smith, Paul Bebbington
    Abstract:

    The role of negative cognition and effect in maintaining psychotic symptoms is increasingly recognized but has yet to be substantiated though longitudinal analysis. Based on an a priori theoretical model, we hypothesized that negative cognition and depressed mood play a direct causal role in maintaining Paranoia in people with psychosis and that the effect of mood is mediated by negative cognition. We used data from the 301 patients in the Prevention of Relapse in Psychosis Trial of cognitive behavior therapy. They were recruited from consecutive Community Mental Health Team clients presenting with a recent relapse of psychosis. The teams were located in inner and outer London and the rural county of Norfolk, England. The study followed a longitudinal cohort design, with initial measures repeated at 3 and 12 months. Structural equation modeling was used to investigate the direction of effect between negative cognition, depressed mood, and Paranoia. Overall fit was ambiguous in some analyses and confounding by unidentified variables cannot be ruled out. Nevertheless, the most plausible models were those incorporating pathways from negative cognition and depressed mood to paranoid symptoms: There was no evidence whatsoever for pathways in the reverse direction. The link between depressed mood and Paranoia appeared to be mediated by negative cognition. Our hypotheses were thus corroborated. This study provides evidence for the role of negative cognition in the maintenance of Paranoia, a role of central relevance, both to the design of psychological interventions and to the conceptualizations of psychosis.

  • the psychological effect of an urban environment on individuals with persecutory delusions the camberwell walk study
    Schizophrenia Research, 2008
    Co-Authors: Lyn Ellett, Daniel Freeman, Philippa Garety
    Abstract:

    Abstract Background Epidemiological studies have found that individuals who live in urban areas are at increased risk of developing psychosis. However it is unknown whether exposure to urban environments exacerbates psychotic symptoms in people who have a diagnosed psychotic disorder. The aim of the study was to examine the psychological and clinical effects of exposure to one specific deprived urban environment on individuals with persecutory delusions. It was predicted that the urban environment would affect emotional and reasoning processes highlighted in a cognitive model of persecutory delusions and would increase Paranoia. Method Thirty patients with persecutory delusions were randomised to exposure to a deprived urban environment or to a brief mindfulness relaxation task. After exposure, assessments of symptoms, reasoning, and affective processes were taken. Thirty matched non-clinical participants also completed the study measures to enable interpretation of the test scores. Results In individuals with persecutory delusions, exposure to the urban environment, rather than participation in a mindfulness task, increased levels of anxiety, negative beliefs about others and jumping to conclusions. It also increased Paranoia. The individuals with persecutory delusions scored significantly differently from the non-clinical group on all measures. Conclusions For individuals with psychosis, spending time in an urban environment makes them think more negatively about other people and increases anxiety and the jumping to conclusions reasoning bias. Their Paranoia is also increased. A number of processes hypothesised in cognitive models to lead to paranoid thoughts are exacerbated by a deprived urban environment. Further research is needed to clarify which aspects of urban environments cause the negative effects. Methodological challenges in the research area are raised.

  • psychological investigation of the structure of Paranoia in a non clinical population
    British Journal of Psychiatry, 2005
    Co-Authors: Daniel Freeman, Philippa Garety, Paul Bebbington, Benjamin Smith, Rebecca Rollinson, David Fowler, Elizabeth Kuipers, Katarzyna Ray, Graham Dunn
    Abstract:

    Background Previous studies of Paranoia have assessed only limited numbers of paranoid thoughts, and have notconsidered the experience from a multidimensional perspective or examined the relationship between different suspicious thoughts. Aims To assess a wide range of paranoid thoughts multidimensionally and examine their distribution, to identify the associated coping strategies and to examine social–cognitive processes and Paranoia. Method Six questionnaire assessments were completed by 1202 individuals using the internet. Results Paranoid thoughts occurred regularly in approximately a third of the group.Increasing endorsement of paranoid thoughts was characterised by the recruitment of rarer and odder ideas. Higher levels of Paranoia were associated with emotional and avoidantcoping, less use of rational and detached coping, negative attitudes to emotional expression, submissive behaviours and lower social rank. Conclusions Suspiciousnessis common and there may be a hierarchical arrangement of such thoughts that builds on common emotional concerns.

Graham Dunn - One of the best experts on this subject based on the ideXlab platform.

  • Digitally supported CBT to reduce Paranoia and improve reasoning for people with schizophrenia-spectrum psychosis: the SlowMo RCT
    'National Institute for Health Research', 2021
    Co-Authors: Philippa Garety, Graham Dunn, Daniel Freeman, Paul Bebbington, David Fowler, Elizabeth Kuipers, Richard Emsley, Thomas Ward, Kathryn Greenwood, Amy Hardy
    Abstract:

    Background: Reasoning may play a causal role in paranoid delusions in psychosis. SlowMo, a new digitally supported cognitive–behavioural therapy, targets reasoning to reduce Paranoia. Objectives: To examine the effectiveness of SlowMo therapy in reducing Paranoia and in improving reasoning, quality of life and well-being, and to examine its mechanisms of action, moderators of effects and acceptability. Design: A parallel-arm, assessor-blind, randomised controlled trial comparing SlowMo plus treatment as usual with treatment as usual alone. An online independent system randomised eligible participants (1 : 1) using randomly varying permuted blocks, stratified by site and Paranoia severity. Setting: Community mental health services in three NHS mental health trusts in England, plus patient identification centres. Participants: A total of 362 participants with schizophrenia-spectrum psychosis. Eligibility criteria comprised distressing and persistent (≥ 3 months) Paranoia. Interventions: Eight face-to-face SlowMo sessions over 12 weeks plus treatment as usual, or treatment as usual alone (control group). Main outcome measures: The primary outcome measure was Paranoia measured by the Green Paranoid Thoughts Scale and its revised version, together with observer-rated measures of persecutory delusions (The Psychotic Symptom Rating Scales delusion scale and delusion items from the Scale for the Assessment of Positive Symptoms). The secondary outcome measures were reasoning (measures of belief flexibility, jumping to conclusions, and fast and slow thinking), well-being, quality of life, schemas, service use and worry. Results: A total of 362 participants were recruited between 1 May 2017 and 14 May 2019: 181 in the SlowMo intervention group and 181 in the treatment-as-usual (control) group. One control participant subsequently withdrew. In total, 325 (90%) participants provided primary Green Paranoid Thoughts Scale outcome data at 12 weeks (SlowMo, n = 162; treatment as usual, n = 163). A total of 145 (80%) participants in the SlowMo group completed all eight therapy sessions. SlowMo was superior to treatment as usual in reducing Paranoia on all three measures used: Green Paranoid Thoughts Scale total at 12 weeks (Cohen’s d = 0.30, 95% confidence interval 0.09 to 0.51; p = 0.005) and 24 weeks (Cohen’s d = 0.20, 95% confidence interval –0.02 to 0.40; p = 0.063); Psychotic Symptom Rating Scales delusions at 12 weeks (Cohen’s d = 0.47, 95% confidence interval 0.17 to 0.78; p = 0.002) and 24 weeks (Cohen’s d = 0.50, 95% confidence interval 0.20 to 0.80; p = 0.001); and Scale for the Assessment of Positive Symptoms persecutory delusions at 12 weeks (Cohen’s d = 0.43, 95% confidence interval 0.03 to 0.84; p = 0.035) and 24 weeks (Cohen’s d = 0.54, 95% confidence interval 0.14 to 0.94; p = 0.009). Reasoning (belief flexibility, possibility of being mistaken and Fast and Slow Thinking Questionnaire measure) improved, but jumping to conclusions did not improve. Worry, quality of life, well-being and self-concept also improved, improving most strongly at 24 weeks. Baseline characteristics did not moderate treatment effects. Changes in belief flexibility and worry mediated changes in Paranoia. Peer researcher-led qualitative interviews confirmed positive experiences of the therapy and technology. Nineteen participants in the SlowMo group and 21 participants in the treatment-as-usual group reported 54 adverse events (51 serious events, no deaths). Limitations: The trial included treatment as usual as the comparator and, thus, the trial design did not control for the effects of time with a therapist. Conclusions: To the best of our knowledge, this is the largest trial of a psychological therapy for Paranoia in people with psychosis and the first trial using a brief targeted digitally supported therapy. High rates of therapy uptake demonstrated acceptability. It was effective for Paranoia, comparable to longer therapy, and equally effective for people with different levels of negative symptoms and working memory. Mediators were improvements in belief flexibility and worry. Our results suggest that targeting reasoning helps Paranoia. Future work: Further examination of SlowMo mechanisms of action and implementation. Trial registration: Current Controlled Trials ISRCTN32448671. Funding: This project was funded by the Efficacy and Mechanism Evaluation (EME) programme, a MRC and National Institute for Health Research (NIHR) partnership. This will be published in full in Efficacy and Mechanism Evaluation; Vol. 8, No. 11. See the NIHR Journals Library website for further project information

  • how cannabis causes Paranoia using the intravenous administration of 9 tetrahydrocannabinol thc to identify key cognitive mechanisms leading to Paranoia
    Schizophrenia Bulletin, 2015
    Co-Authors: Daniel Freeman, Angus Antley, Mel Slater, Graham Dunn, Rachel Lister, Nicole Evans, Robin M Murray, B Godlewska, Robert Cornish
    Abstract:

    Paranoia is receiving increasing attention in its own right, since it is a central experience of psychotic disorders and a marker of the health of a society. Paranoia is associated with use of the most commonly taken illicit drug, cannabis. The objective was to determine whether the principal psychoactive ingredient of cannabis—∆9-tetrahydrocannabinol (THC)—causes Paranoia and to use the drug as a probe to identify key cognitive mechanisms underlying Paranoia. A randomized, placebo-controlled, between-groups test of the effects of intravenous THC was conducted. A total of 121 individuals with paranoid ideation were randomized to receive placebo, THC, or THC preceded by a cognitive awareness condition. Paranoia was assessed extensively via a real social situation, an immersive virtual reality experiment, and standard self-report and interviewer measures. Putative causal factors were assessed. Principal components analysis was used to create a composite Paranoia score and composite causal variables to be tested in a mediation analysis. THC significantly increased Paranoia, negative affect (anxiety, worry, depression, negative thoughts about the self), and a range of anomalous experiences, and reduced working memory capacity. The increase in negative affect and in anomalous experiences fully accounted for the increase in Paranoia. Working memory changes did not lead to Paranoia. Making participants aware of the effects of THC had little impact. In this largest study of intravenous THC, it was definitively demonstrated that the drug triggers paranoid thoughts in vulnerable individuals. The most likely mechanism of action causing Paranoia was the generation of negative affect and anomalous experiences.

  • current paranoid thinking in patients with delusions the presence of cognitive affective biases
    Schizophrenia Bulletin, 2013
    Co-Authors: Daniel Freeman, Graham Dunn, Philippa Garety, Paul Bebbington, David Fowler, Elizabeth Kuipers, Richard Emsley, Suzanne Jolley
    Abstract:

    Background: There has been renewed interest in the influence of affect on psychosis. Psychological research on persecutory delusions ascribes a prominent role to cognitive processes related to negative affect: anxiety leads to the anticipation of threat within Paranoia; depressive negative ideas about the self create a sense of vulnerability in which paranoid thoughts flourish; and self-consciousness enhances feelings of the self as a target. The objective of this study was to examine such affective processes in relation to state Paranoia in patients with delusions. Methods: 130 patients with delusions in the context of a nonaffective psychosis diagnosis (predominately schizophrenia) were assessed for contemporaneous levels of persecutory ideation on 5 visual analog scales. Measures were taken of anxiety, depression, threat anticipation, interpretation of ambiguity, self-focus, and negative ideas about the self. Results: Of the patients, 85% report paranoid thinking at testing. Symptoms of anxiety and depression were highly prevalent. Current paranoid thinking was associated with anxiety, depression, greater anticipation of threat events, negative interpretations of ambiguous events, a self-focused cognitive style, and negative ideas about the self. Conclusions: The study provides a clear demonstration that a range of emotion-related cognitive biases, each of which could plausibly maintain delusions, are associated with current paranoid thinking in patients with psychosis. We identified biases both in the contents of cognition and in the processing of information. Links between affect and psychosis are central to the understanding of schizophrenia. We conclude that treatment of emotional dysfunction should lead to reductions in current psychotic experiences.

  • negative cognition depressed mood and Paranoia a longitudinal pathway analysis using structural equation modeling
    Schizophrenia Bulletin, 2012
    Co-Authors: David Fowler, Graham Dunn, Daniel Freeman, Philippa Garety, Elizabeth Kuipers, Joanne Hodgekins, Ben Smith, Paul Bebbington
    Abstract:

    The role of negative cognition and effect in maintaining psychotic symptoms is increasingly recognized but has yet to be substantiated though longitudinal analysis. Based on an a priori theoretical model, we hypothesized that negative cognition and depressed mood play a direct causal role in maintaining Paranoia in people with psychosis and that the effect of mood is mediated by negative cognition. We used data from the 301 patients in the Prevention of Relapse in Psychosis Trial of cognitive behavior therapy. They were recruited from consecutive Community Mental Health Team clients presenting with a recent relapse of psychosis. The teams were located in inner and outer London and the rural county of Norfolk, England. The study followed a longitudinal cohort design, with initial measures repeated at 3 and 12 months. Structural equation modeling was used to investigate the direction of effect between negative cognition, depressed mood, and Paranoia. Overall fit was ambiguous in some analyses and confounding by unidentified variables cannot be ruled out. Nevertheless, the most plausible models were those incorporating pathways from negative cognition and depressed mood to paranoid symptoms: There was no evidence whatsoever for pathways in the reverse direction. The link between depressed mood and Paranoia appeared to be mediated by negative cognition. Our hypotheses were thus corroborated. This study provides evidence for the role of negative cognition in the maintenance of Paranoia, a role of central relevance, both to the design of psychological interventions and to the conceptualizations of psychosis.

  • what makes one person paranoid and another person anxious the differential prediction of social anxiety and persecutory ideation in an experimental situation
    Psychological Medicine, 2008
    Co-Authors: Daniel Freeman, Matthew Gittins, Katherine Pugh, Angus Antley, Mel Slater, Graham Dunn
    Abstract:

    Results. The strongest finding was that the presence of perceptual anomalies increased the risk of paranoid reactions but decreased the risk of social anxiety. Anxiety, depression, worry and interpersonal sensitivity all had similar associations with Paranoia and social anxiety. Conclusions. The study shows that social anxiety and persecutory ideation share many of the same predictive factors. Non-clinical Paranoia may be a type of anxious fear. However, perceptual anomalies are a distinct predictor of Paranoia. In the context of an individual feeling anxious, the occurrence of odd internal feelings in social situations may lead to delusional ideas through a sense of ‘ things not seeming right ’. The study illustrates the approach of focusing on experiences such as paranoid thinking rather than diagnoses such as schizophrenia.

Roos Potkolder - One of the best experts on this subject based on the ideXlab platform.

  • cost effectiveness of virtual reality cognitive behavioral therapy for psychosis health economic evaluation within a randomized controlled trial
    Journal of Medical Internet Research, 2020
    Co-Authors: Roos Potkolder, Wim Veling, Chris N W Geraets, Joran Lokkerbol, Filip Smit, Alyssa Jongeneel, Helga K Ising, Mark Van Der Gaag
    Abstract:

    Background: Evidence was found for the effectiveness of virtual reality-based cognitive behavioral therapy (VR-CBT) for treating Paranoia in psychosis, but health-economic evaluations are lacking. Objective: This study aimed to determine the short-term cost-effectiveness of VR-CBT. Methods: The health-economic evaluation was embedded in a randomized controlled trial evaluating VR-CBT in 116 patients with a psychotic disorder suffering from paranoid ideation. The control group (n=58) received treatment as usual (TAU) for psychotic disorders in accordance with the clinical guidelines. The experimental group (n=58) received TAU complemented with add-on VR-CBT to reduce paranoid ideation and social avoidance. Data were collected at baseline and at 3 and 6 months postbaseline. Treatment response was defined as a pre-post improvement of symptoms of at least 20% in social participation measures. Change in quality-adjusted life years (QALYs) was estimated by using Sanderson et al’s conversion factor to map a change in the standardized mean difference of Green’s Paranoid Thoughts Scale score on a corresponding change in utility. The incremental cost-effectiveness ratios were calculated using 5000 bootstraps of seemingly unrelated regression equations of costs and effects. The cost-effectiveness acceptability curves were graphed for the costs per treatment responder gained and per QALY gained. Results: The average mean incremental costs for a treatment responder on social participation ranged between €8079 and €19,525, with 90.74%-99.74% showing improvement. The average incremental cost per QALY was €48,868 over the 6 months of follow-up, with 99.98% showing improved QALYs. Sensitivity analyses show costs to be lower when relevant baseline differences were included in the analysis. Average costs per treatment responder now ranged between €6800 and €16,597, while the average cost per QALY gained was €42,030. Conclusions: This study demonstrates that offering VR-CBT to patients with paranoid delusions is an economically viable approach toward improving patients’ health in a cost-effective manner. Long-term effects need further research. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) 12929657; http://www.isrctn.com/ISRCTN12929657

  • virtual reality based cognitive behavioural therapy versus waiting list control for paranoid ideation and social avoidance in patients with psychotic disorders a single blind randomised controlled trial
    The Lancet Psychiatry, 2018
    Co-Authors: Roos Potkolder, Wim Veling, Chris N W Geraets, Marije Van Beilen, A B P Staring, Harm J Gijsman, Philippe Delespaul, Mark Van Der Gaag
    Abstract:

    Summary Background Many patients with psychotic disorders have persistent paranoid ideation and avoid social situations because of suspiciousness and anxiety. We investigated the effects of virtual-reality-based cognitive behavioural therapy (VR-CBT) on paranoid thoughts and social participation. Methods In this randomised controlled trial at seven Dutch mental health centres, outpatients aged 18–65 years with a DSM-IV-diagnosed psychotic disorder and paranoid ideation in the past month were randomly assigned (1:1) via block randomisation to VR-CBT (in addition to treatment as usual) or the waiting list control group (treatment as usual). VR-CBT consisted of 16 individual therapy sessions (each 1 h long). Assessments were done at baseline, after treatment (ie, 3 months from baseline), and at a 6 month follow-up visit. The primary outcome was social participation, which we operationalised as the amount of time spent with other people, momentary Paranoia, perceived social threat, and momentary anxiety. Analysis was by intention to treat. This trial was retrospectively registered with ISRCTN, number 12929657. Findings Between April 1, 2014, and Dec 31, 2015, 116 patients with a psychotic disorder were randomly assigned, 58 to the VR-CBT group and 58 to the waiting list control group. Compared with the control, VR-CBT did not significantly increase the amount of time spent with other people at the post-treatment assessment. Momentary paranoid ideation (b=–0·331 [95% CI −0·432 to −0·230], p Interpretation Our results suggest that the addition of VR-CBT to standard treatment can reduce paranoid ideation and momentary anxiety in patients with a psychotic disorder. Funding Fonds NutsOhra, Stichting tot Steun VCVGZ.

  • environmental social stress Paranoia and psychosis liability a virtual reality study
    Schizophrenia Bulletin, 2016
    Co-Authors: Wim Veling, Jim Van Os, Roos Potkolder, Jacqueline Counotte, Mark Van Der Gaag
    Abstract:

    The impact of social environments on mental states is difficult to assess, limiting the understanding of which aspects of the social environment contribute to the onset of psychotic symptoms and how individual characteristics moderate this outcome. This study aimed to test sensitivity to environmental social stress as a mechanism of psychosis using Virtual Reality (VR) experiments. Fifty-five patients with recent onset psychotic disorder, 20 patients at ultra high risk for psychosis, 42 siblings of patients with psychosis, and 53 controls walked 5 times in a virtual bar with different levels of environmental social stress. Virtual social stressors were population density, ethnic density and hostility. Paranoia about virtual humans and subjective distress in response to virtual social stress exposures were measured with State Social Paranoia Scale (SSPS) and self-rated momentary subjective distress (SUD), respectively. Pre-existing (subclinical) symptoms were assessed with the Community Assessment of Psychic Experiences (CAPE), Green Paranoid Thoughts Scale (GPTS) and the Social Interaction Anxiety Scale (SIAS). Paranoia and subjective distress increased with degree of social stress in the environment. Psychosis liability and pre-existing symptoms, in particular negative affect, positively impacted the level of Paranoia and distress in response to social stress. These results provide experimental evidence that heightened sensitivity to environmental social stress may play an important role in the onset and course of psychosis.