RESUMO
OBJECTIVE: To unite within the framework of a single clinical entity (based on the model of hypochondriacal paranoia) phenomena of the somatopsychotic and hypochondriacal range, which, in accordance with modern systematics, are classified as various categories of psychosomatic, affective disorders and personality disorders. MATERIAL AND METHODS: The sample for analysis consisted of 29 patients (with the diagnosis of delusional disorder (ICD-10; F22.0 in ICD-10), 10 men (34.5%) and 19 women (64.5%), the average age was 42.9±19.9 years; men - 10 nab. (34.5%), women - 19 nab. (64.5%). The average duration of the disease iswas 9.4±8.5 years. The psychopathological method was used as the main one. RESULTS: The article forms an alternative concept of somatic paranoia based on the model of hypochondriacal paranoia. The fundamental difference between the construct of somatic paranoia is an obligate connection between somatopsychic and ideational disorders. Somatopsychic (coenesthesiopathic) symptoms do not exist as an independent (equivalent to the structure of somatic clinical syndromes) dimensions and are formed exclusively with the participation of ideational phenomena. CONCLUSION: In accordance with the presented concept, coenesthesiopathic symptoms within the framework of somatic paranoia act as a somatic equivalent of delusional disorders.
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Transtornos Paranoides , Transtornos Psicofisiológicos , Masculino , Humanos , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Transtornos Paranoides/diagnóstico , Transtornos Paranoides/psicologia , Transtornos Psicofisiológicos/diagnóstico , Transtornos da Personalidade/diagnóstico , Classificação Internacional de Doenças , Síndrome , DelusõesRESUMO
The felt presence experience is the basic feeling that someone else is present in the immediate environment, without clear sensory evidence. Ranging from benevolent to distressing, personified to ambiguous, felt presence has been observed in neurological case studies and within psychosis and paranoia, associated with sleep paralysis and anxiety, and recorded within endurance sports and spiritualist communities. In this Review, we summarise the philosophical, phenomenological, clinical, and non-clinical correlates of felt presence, as well as current approaches that use psychometric, cognitive, and neurophysiological methods. We present current mechanistic explanations for felt presence, suggest a unifying cognitive framework for the phenomenon, and discuss outstanding questions for the field. Felt presence offers a sublime opportunity to understand the cognitive neuroscience of own-body awareness and social agency detection, as an intuitive, but poorly understood, experience in health and disorder.
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Transtornos Psicóticos , Humanos , Transtornos Psicóticos/psicologia , Emoções , Cognição , Transtornos Paranoides/psicologia , ConscientizaçãoRESUMO
BACKGROUND: Childhood trauma is associated with a variety of negative outcomes in psychosis, but it is unclear clear if childhood trauma affects day-to-day social experiences. We aimed to examine the association between childhood trauma and functional and structural characteristics of real-world social relationships in psychosis. METHODS: Participants with psychotic disorders or affective disorders with psychosis completed ecological momentary assessments (EMAs) over ten days (N = 209). Childhood trauma was assessed retrospectively using the Childhood Trauma Questionnaire. Associations between childhood trauma and EMA-assessed social behavior and perceptions were examined using linear mixed models. Analyses were adjusted for sociodemographic characteristics and psychotic and depressive symptom severity. RESULTS: Higher levels of childhood trauma were associated with more perceived threat (B = -0.19, 95 % CI [-0.33, -0.04]) and negative self-perception (B = -0.18, 95 % CI [-0.34, -0.01]) during recent social interactions, as well as reduced social motivation (B = -0.29, 95 % CI [-0.47, -0.10]), higher desire for social avoidance (B = 0.34, 95 % CI [0.14, 0.55]), and lower sense of belongingness (B = -0.24, 95 % CI [-0.42, -0.06]). These negative social perceptions were mainly linked with emotional abuse and emotional neglect. In addition, paranoia was more strongly associated with negative social perceptions in individuals with high versus low levels of trauma. Childhood trauma was not associated with frequency (i.e., time spent alone) or type of social interactions. CONCLUSION: Childhood trauma - particularly emotional abuse and neglect - is associated with negative social perceptions but not frequency of real-world social interactions. Our findings suggest that childhood trauma may affect day-to-day social experiences beyond its association with psychosis.
Assuntos
Transtornos Psicóticos , Humanos , Estudos Retrospectivos , Transtornos Psicóticos/psicologia , Transtornos Paranoides/psicologia , Inquéritos e Questionários , Transtornos do HumorRESUMO
Inferring causes of the good and bad events that we experience is part of the process of building models of our own capabilities and of the world around us. Making such inferences can be difficult because of complex reciprocal relationships between attributions of the causes of particular events, and beliefs about the capabilities and skills that influence our role in bringing them about. Abnormal causal attributions have long been studied in connection with psychiatric disorders, notably depression and paranoia; however, the mechanisms behind attributional inferences and the way they can go awry are not fully understood. We administered a novel, challenging, game of skill to a substantial population of healthy online participants, and collected trial-by-trial time series of both their beliefs about skill and attributions about the causes of the success and failure of real experienced outcomes. We found reciprocal relationships that provide empirical confirmation of the attribution-self representation cycle theory. This highlights the dynamic nature of the processes involved in attribution, and validates a framework for developing and testing computational accounts of attribution-belief interactions.
Assuntos
Percepção Social , Jogos de Vídeo , Humanos , Transtornos Paranoides/psicologiaRESUMO
Theoretical accounts suggest heightened uncertainty about the state of the world underpin aberrant belief updates, which in turn increase the risk of developing a persecutory delusion. However, this raises the question as to how an agent's uncertainty may relate to the precise phenomenology of paranoia, as opposed to other qualitatively different forms of belief. We tested whether the same population (n = 693) responded similarly to non-social and social contingency changes in a probabilistic reversal learning task and a modified repeated reversal Dictator game, and the impact of paranoia on both. We fitted computational models that included closely related parameters that quantified the rigidity across contingency reversals and the uncertainty about the environment/partner. Consistent with prior work we show that paranoia was associated with uncertainty around a partner's behavioural policy and rigidity in harmful intent attributions in the social task. In the non-social task we found that pre-existing paranoia was associated with larger decision temperatures and commitment to suboptimal cards. We show relationships between decision temperature in the non-social task and priors over harmful intent attributions and uncertainty over beliefs about partners in the social task. Our results converge across both classes of model, suggesting paranoia is associated with a general uncertainty over the state of the world (and agents within it) that takes longer to resolve, although we demonstrate that this uncertainty is expressed asymmetrically in social contexts. Our model and data allow the representation of sociocognitive mechanisms that explain persecutory delusions and provide testable, phenomenologically relevant predictions for causal experiments.
Assuntos
Transtornos Paranoides , Aprendizado Social , Delusões/psicologia , Humanos , Aprendizagem , Transtornos Paranoides/psicologia , IncertezaRESUMO
BACKGROUND AND HYPOTHESIS: Influential models of psychosis indicate that the impact of putative causal factors on positive symptoms might be explained partly through affective disturbances. We aimed to investigate whether pathways from stress and self-esteem to positive symptoms, as well as reversal pathways from symptoms to stress and self-esteem, were mediated through specific affective disturbances across the extended psychosis phenotype. STUDY DESIGN: Using experience sampling methodology, 178 participants (65 high-schizotypy, 74 at-risk mental state, and 39 first-episode psychosis) were assessed on levels of momentary stress, self-esteem, anxiety, sadness, psychotic-like experiences (PLE), and paranoia. Multilevel mediation models were fit to examine indirect effects of each of these pathways. Considering evidence of mediation, each indirect pathway will be combined in a single model to explore their relative contributions. STUDY RESULTS: Anxiety, sadness, and self-esteem mediated the pathways from stress to PLE and paranoia in daily-life. In the pathway to paranoia, sadness, and self-esteem showed larger contributions than anxiety. Pathways from self-esteem to PLE and paranoia were mediated by anxiety and sadness, the later showing a larger contribution. Pathways from symptoms to stress, but not from symptoms to self-esteem, were differently explained by emotional states; sadness lost its mediating effect and anxiety was the most important mediator. Few differences across groups were found. CONCLUSIONS: This study lends support to psychological models of psychosis that highlight the relevance of affective disturbances in the risk and expression of psychosis. Furthermore, specific influences of different negative emotional states were identified, which could enhance psychological treatments.
Assuntos
Transtornos Paranoides , Transtornos Psicóticos , Ansiedade , Emoções , Humanos , Transtornos Paranoides/psicologia , Transtornos Psicóticos/complicações , AutoimagemRESUMO
OBJECTIVES: Attenuated symptoms of psychosis are a core feature of At-Risk Mental States. However, subthreshold levels of paranoia are also common among nonpsychosis populations. At present, little is known about whether the processes underpinning the experience of paranoid ideation in high-risk youth differ as a consequence of meeting At-Risk Mental States (ARMS) for psychosis criteria. METHODS: This study utilized path analysis techniques to examine the relationships between schematic beliefs, negative affect and the experience of paranoia for two groups: a group meeting criteria for ARMS (n = 133) and a group presenting with emerging complex mental health difficulties who did not meet the criteria for ARMS (n = 137). RESULTS: While the ARMS group displayed significantly greater maladaptive schematic beliefs and more severe symptomatology, the associations between schematic beliefs, symptoms of negative affect and paranoia did not differ as a consequence of ARMS status. CONCLUSIONS: While meeting the ARMS criteria is associated with experiencing more maladaptive cognitions and more negative symptomatology among at-risk youth, the associations between these cognitive beliefs and symptoms may be similar for youth who do not meet ARMS. These findings have implications for broadening the scope of at-risk/high-risk and for developing effective interventions for young people presenting with emerging difficulties.
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Transtornos Paranoides , Transtornos Psicóticos , Adolescente , Cognição , Humanos , Transtornos Paranoides/psicologia , Transtornos Psicóticos/psicologia , Fatores de RiscoRESUMO
Paranoid ideas are the most common abnormal beliefs in the schizophrenia spectrum, are also prevalent in non-clinical populations, and are highly correlated with other mental health problems such as anxiety, depression and low levels of well-being. Two previous studies with the same British population sample used confirmatory factor analysis and network analysis to show that the spectrum of paranoid beliefs is made up of four factors or dimensions (i.e., interpersonal sensitivity, mistrust, ideas of reference and ideas of persecution). The aims of this study are: 1) to explore the distribution and the structure of paranoid beliefs in a Spanish general population by applying the network approach and 2) to use network analysis to explore for the first time whether specific domains of paranoid ideation (i.e., dimensions) are specifically associated with mental health correlates such as depression, anxiety, loneliness, and well-being. We found a continuous distribution of paranoid beliefs among the 1328 individuals constituting the sample (e.g., 29,2 % did not endorse any items, 4.6 % endorsed half of the items, while 0.8 % endorsed all paranoid items). Paranoid ideas form three dimensions; interpersonal sensitivity, mistrust, and ideas of persecution (ideas of reference did not form a separate factor). The network model showed that loneliness has a pivotal role in connecting paranoid ideation with general psychopathology measures (i.e., depression, anxiety, loneliness and well-being). Research and clinical implications derived from our findings are also discussed.
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Solidão , Transtornos Paranoides , Humanos , Relações Interpessoais , Saúde Mental , Transtornos Paranoides/psicologia , Fatores de RiscoRESUMO
OBJECTIVES: Paranoia describes unfounded interpersonal threat beliefs. Secure attachment imagery attenuates paranoia, but limited research examines mechanisms of change and no studies examine how secure imagery may be implemented most effectively in clinical practice. In this study, we tested: (a) the causal impact of secure, anxious, and avoidant attachment imagery on paranoia and anxiety, (b) whether emotion regulation strategies mediate these relationships, and (c) whether secure imagery buffers against social stress. DESIGN: We utilized a longitudinal, experimental design. METHOD: A general population sample with high non-clinical paranoia (N = 265) completed measures of paranoia, anxiety, and emotion regulation strategies. Participants were randomly allocated to secure, anxious, or avoidant conditions and repeated an imagery prime for four days prior to a social stress task. RESULTS: Relative to anxious and avoidant imagery, secure imagery decreased state paranoia and anxiety. These associations were not mediated by state emotion regulation strategies, and secure imagery did not buffer against stress. Exploratory analyses on trait variables revealed that: (a) hyperactivating strategies mediated the association between attachment anxiety and paranoia, and (b) suppression mediated the association between attachment avoidance and paranoia. CONCLUSIONS: Secure attachment imagery reduces state paranoia and anxiety and could be incorporated into psychotherapies to attenuate clinical paranoia. Measurement of state emotion regulation was problematic. Attachment imagery does not buffer stress; further research is required to test whether secure imagery facilitates recovery from stress. Attachment style is likely to account for trait paranoia via attachment-congruent emotion regulation strategies. Research is now needed to determine if these strategies can be targeted to alleviate paranoia in clinical populations.
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Regulação Emocional , Transtornos Paranoides , Ansiedade/psicologia , Humanos , Imagens, Psicoterapia , Apego ao Objeto , Transtornos Paranoides/psicologia , Transtornos Paranoides/terapiaRESUMO
INTRODUCTION: Paranoia in community samples is associated with higher levels of depression, anxiety symptoms and suicidality. The metacognitive model assumes the role of metacognitive factors in these associations. Positive and negative metacognitive beliefs (PMB and NMB, respectively) and cognitive-attentional syndrome (CAS) are to mediate between paranoia-like beliefs and psychopathology symptoms. The current study is an attempt to test this prediction. METHODS: A cross-sectional community study with n = 840 participants. We used R-GPTS's persecutory subscale to measure paranoia-like beliefs, CAS-1 for CAS and metacognitive beliefs and SCL-27-plus for psychopathology symptoms. RESULTS: Indirect effects of PMB, CAS and NMB accounted for 22% to 56% (CI 95%) of total effects of relationships between paranoia-like beliefs and vegetative symptoms, symptoms of social phobia, agoraphobia, depression and suicidality screening. CONCLUSIONS: We demonstrated that PMB, CAS and NMB mediate between paranoia-like beliefs and various psychopathological symptoms, as predicted by the metacognitive model of psychopathology. We also uncovered other indirect effects, including negative mediation effect of PMB on the relationship between paranoia-like beliefs and depressive symptoms and suicidality.
Assuntos
Metacognição , Transtornos Paranoides , Ansiedade/psicologia , Estudos Transversais , Emoções , Humanos , Transtornos Paranoides/psicologiaRESUMO
Previous research has indicated that lifetime body image concerns are associated with increased odds of paranoid ideation. In this study, we sought to replicate and extend this finding by exploring how paranoia relates to different aspects of body image concern using a comprehensive, cross-sectional design. Women without a mental health diagnosis (n = 119) completed online questionnaires assessing paranoia, shape and weight concerns, and figure ratings for how they "think" their body looks and how they "feel" in their body. Participant's "actual" figure ratings were estimated from height and weight; discrepancy scores were then calculated for "actual-think" and "actual-feel" figure ratings. Correlational analyses, and mediation models testing paranoia as a mediator between "actual-feel" and shape and weight concerns, were conducted. Paranoia was significantly correlated with increased shape and weight concerns, and with "feeling" larger. Paranoia significantly mediated paths from feeling larger to increased shape or weight concerns. There were no significant associations of paranoia with "actual-think" ratings. Limitations include that height and weight data could not be objectively confirmed, and only women were included in the study. Further research is needed to understand mechanisms by which paranoia may influence shape and weight concerns and vice versa, and how "feeling" larger may feed paranoia. Future research should investigate these relationships among clinical eating disorder groups.
Assuntos
Imagem Corporal , Transtornos da Alimentação e da Ingestão de Alimentos , Imagem Corporal/psicologia , Peso Corporal , Estudos Transversais , Emoções , Feminino , Humanos , Transtornos Paranoides/psicologiaRESUMO
BACKGROUND: Persecutory delusions are among the most common delusions in schizophrenia and represent the extreme end of the paranoia continuum. Paranoia is accompanied by significant worry and distress. Identifying cognitive mechanisms underlying paranoia is critical for advancing treatment. We hypothesized that aberrant belief updating, which is related to paranoia in human and animal models, would also contribute to persecutory beliefs in individuals with schizophrenia. METHODS: Belief updating was assessed in 42 participants with schizophrenia and 44 healthy control participants using a 3-option probabilistic reversal learning task. Hierarchical Gaussian Filter was used to estimate computational parameters of belief updating. Paranoia was measured using the Positive and Negative Syndrome Scale and the revised Green et al. Paranoid Thoughts Scale. Unusual thought content was measured with the Psychosis Symptom Rating Scale and the Peters et al. Delusions Inventory. Worry was measured using the Dunn Worry Questionnaire. RESULTS: Paranoia was significantly associated with elevated win-switch rate and prior beliefs about volatility both in schizophrenia and across the whole sample. These relationships were specific to paranoia and did not extend to unusual thought content or measures of anxiety. We observed a significant indirect effect of paranoia on the relationship between prior beliefs about volatility and worry. CONCLUSIONS: This work provides evidence that relationships between belief updating parameters and paranoia extend to schizophrenia, may be specific to persecutory beliefs, and contribute to theoretical models implicating worry in the maintenance of persecutory delusions.
Assuntos
Transtornos Paranoides , Esquizofrenia , Humanos , Transtornos Paranoides/diagnóstico , Transtornos Paranoides/psicologia , Transtornos Paranoides/terapia , Esquizofrenia/complicações , Esquizofrenia/diagnóstico , Delusões , Ansiedade/psicologia , Inquéritos e QuestionáriosRESUMO
Previous research has demonstrated significant associations between adverse childhood experiences (ACEs) and risks of psychosis. Further research has examined underlying mechanisms to understand the relationship between these variables. This review aimed to explore the associations between various ACEs and the development of different psychotic symptoms in adulthood. The Cochrane Library, Cinahl, PsychINFO, Medline, Embase, and Web of Science were searched from January 1980 to November 2021 to ensure a systematic review of relevant literature. Poverty, fostering, adoption, childhood emotional and physical neglect, and childhood physical (CPA), sexual (CSA), and emotional abuse (CEA) significantly correlated with delusions. Significant relationships were found between hallucinations and CSA and CPA. Paranoia correlated with violent adversities including CPA, assault, and witnessing killing. Limited associations were identified for thought disorder and negative symptoms. The findings of this review indicate that there may be a degree of specificity between various ACEs and psychotic symptoms, but these findings are subject to some limitations. The findings also demonstrate the importance of inquiring about and addressing ACE in clinical practice to develop formulations and treatment plans for individuals with psychosis.
Assuntos
Experiências Adversas da Infância , Maus-Tratos Infantis , Transtornos Psicóticos , Adulto , Criança , Alucinações/etiologia , Alucinações/psicologia , Humanos , Transtornos Paranoides/psicologia , Transtornos Psicóticos/complicações , Transtornos Psicóticos/psicologiaRESUMO
OBJECTIVES: Paranoia is most likely to emerge in adolescence. In adolescents with mental health disorders, the disruptive effect of paranoia on social relationships could worsen outcomes. However, little is known about clinical presentations of paranoia at this age. We therefore explored the development, experience, and impact of paranoia in adolescent patients. DESIGN: A qualitative interview design with interpretative phenomenological analysis was used. METHOD: Twelve adolescents (11-17 years) with paranoia attending child and adolescent mental health services were interviewed. RESULTS: Adolescents described a journey starting with their awareness of paranoia beginning to a paranoid experience of mistrust and fear of others, and, subsequently, their adjustment to paranoia in daily life. Paranoia onset was rooted in the discovery of interpersonal threat and personal vulnerability, shaped by challenging peer interactions, becoming aware of danger in the world, and personal adverse experiences. The paranoia experience included a struggle to trust friends, anticipating threat with intense fear, and using defensive strategies to keep safe. Adolescents described how the paranoia experience was confusing, negatively impacted self-concept, held them back from teenage life, and caused disconnection from friends. Longer-term responses to paranoia reflected a tension between reluctantly resigning to the experience and trying to resist the impact. CONCLUSIONS: The journey of paranoia in adolescence involves navigating multiple tensions, with young people balancing independence with vulnerability, trust with mistrust, and the desire to socialise with a fear of danger and deception. Decisions about how to respond to paranoia are likely to determine the next stage of their journey.
Assuntos
Serviços de Saúde Mental , Transtornos Paranoides , Adolescente , Criança , Medo , Humanos , Relações Interpessoais , Transtornos Paranoides/psicologia , AutoimagemRESUMO
BACKGROUND: The relationship between attachment and paranoia is now well established. There is good theoretical reason and evidence to indicate that attachment style affects cognitive, affective, and behavioural processes which, in turn, contribute to the maintenance of paranoia, but this research has not been integrated. We critically and systematically review research that examines relevant cognitive, affective, and behavioural processes, which may explain how attachment insecurity leads to paranoia and constitute key targets in psychotherapeutic interventions for people with psychosis. METHOD: We conducted three systematic searches across six databases (PsycINFO, CINAHL, Medline, Web of Science, Embase, and Google Scholar), from inception to September 2021, to investigate key cognitive, affective, and behavioural processes in the attachment-paranoia association. RESULTS: We identified a total of 1930 papers and critically reviewed 16. The literature suggests that negative self- and other-beliefs, inability to defuse from unhelpful cognitions, and use of maladaptive emotion regulation strategies mediate the association between attachment insecurity and paranoia in people with psychosis/psychotic experience. Attachment-secure people with psychosis are more likely to seek help and engage with services than attachment-insecure people. CONCLUSIONS: Attachment styles impact help-seeking behaviours in people with psychosis and are likely to influence paranoia via self- and other-beliefs, cognition fusion, and emotion regulation - these candidate mechanisms may be targeted in psychological therapy to improve clinical outcomes for people with psychosis, characterized by paranoia. PRACTITIONER POINTS: Insecure attachment is likely to lead to paranoia via negative beliefs about self and others, cognitive fusion, and use of maladaptive emotion regulation strategies. These mechanisms can be targeted in psychotherapeutic interventions for psychosis, such as cognitive behaviour therapy, to improve clinical and recovery outcomes. People with psychosis who are attachment-secure are more likely to seek help and engage with services than those who are attachment-insecure (particularly avoidant). Attachment style can be assessed to predict service engagement and help-seeking behaviours in people with psychosis. Attachment styles are important predictors of key cognitive, affective, and behavioural processes in people with psychosis. These processes can be assessed and incorporated into individualised formulations, and then targeted in therapy to effect psychotherapeutic change.
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Regulação Emocional , Transtornos Psicóticos , Cognição , Humanos , Apego ao Objeto , Transtornos Paranoides/psicologia , Transtornos Paranoides/terapia , Transtornos Psicóticos/psicologiaRESUMO
BACKGROUND: Paranoia is common across the clinical and non-clinical spectrum. Cognitive behavioural therapy for psychosis currently yields modest results, warranting research into symptom-specific maintenance factors to improve outcomes. There is strong evidence of a relationship between insecure attachment and increased paranoia, but little is known about the mediating mechanisms. Emotion dysregulation is associated with both insecure attachment and paranoia, and a candidate causal mechanism. AIMS: This study aimed to determine if emotion dysregulation mediates the association between attachment and paranoia. METHOD: Sixty-two individuals with elevated paranoia were recruited from NHS services and community settings across the South of England. Mediation analyses were conducted on trait attachment, emotion regulation and paranoia variables, which were collected at one time point. RESULTS: As predicted, emotion dysregulation mediated the relationship between attachment avoidance and paranoia, and between attachment anxiety and paranoia. Emotion suppression did not mediate the relationship between attachment avoidance and paranoia, possibly due to power. Attachment avoidance correlated with deactivating emotion regulation strategies (e.g. lack of emotional awareness) and attachment anxiety correlated with hyperactivating emotion regulation strategies (e.g. impulse control difficulties). Both deactivating and hyperactivating strategies correlated with paranoia. CONCLUSION: Emotion dysregulation is not routinely targeted in cognitive behavioural therapy for psychosis. This study suggests that incorporating emotion regulation strategies in therapy may improve clinical outcomes. Experimental studies are now required to support a causal argument, and pilot intervention studies should investigate if emotion regulation skills development (aligned with attachment style) is effective in reducing non-clinical and clinical paranoia.
Assuntos
Regulação Emocional , Transtornos Psicóticos , Emoções , Humanos , Apego ao Objeto , Transtornos Paranoides/psicologia , Transtornos Psicóticos/psicologiaRESUMO
OBJECTIVES: SlowMo therapy is a pioneering blended digital therapy for paranoia, augmenting face-to-face therapy with an interactive 'webapp' and a mobile app. A recent large-scale trial demonstrated small-moderate effects on paranoia alongside improvements in self-esteem, worry, well-being and quality of life. This paper provides a comprehensive account of therapy personalisation within this targeted approach. DESIGN: Case examples illustrate therapy delivery and descriptive data are presented on personalised thought content. METHOD: Thought content was extracted from the webapp (n = 140 participants) and coded using newly devised categories: Worries: (1) Persecutory, (2) Negative social evaluation, (3) Negative self-concept, (4) Loss/life stresses, (5) Sensory-perceptual experiences and (6) Health anxieties. Safer thoughts: (1) Safer alternative (specific alternatives to worries), (2) Second-wave (generalised) coping, (3) Positive self-concept, (4) Positive activities and (5) Third-wave (mindfulness-based) coping. Data on therapy fidelity are also presented. RESULTS: Worries: 'Persecutory' (92.9% of people) and 'Negative social evaluation' (74.3%) were most common. 'General worries/ life stresses' (31.4%) and 'Negative self-concept' (22.1%) were present in a significant minority; 'Health anxieties' (10%) and 'Sensory-perceptual' (10%) were less common. Safer thoughts: 'Second-wave (general) coping' (85%), 'Safer alternatives' (76.4%), 'Positive self-concept' (65.7%) and 'Positive activities' (64.3%) were common with 'Third-wave' (mindfulness) coping observed for 30%. Fidelity: Only three therapy withdrawals were therapy related. Session adherence was excellent (mean = 15.2/16; SD = 0.9). Behavioural work was conducted with 71% of people (119/168). CONCLUSION: SlowMo therapy delivers a targeted yet personalised approach. Potential mechanisms of action extend beyond reasoning. Implications for cognitive models of paranoia and causal interventionist approaches are discussed.
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Transtornos Paranoides , Qualidade de Vida , Ansiedade/psicologia , Medo , Humanos , Transtornos Paranoides/psicologia , Transtornos Paranoides/terapia , AutoimagemRESUMO
OBJECTIVE: Paranoia is known to vary with levels of coalitional threat and safety present in the social environment. However, it remains underexplored whether threat and safety are differentially associated with paranoia, if these relationships vary with the source of threat and safety, and whether such effects hold across the continuum of severity of paranoid thoughts. METHODS: We employed a network analysis approach with community analysis on a large dataset (n = 6,337), the UK Adult Psychiatric Morbidity Survey 2007, to explore these questions. We included one node to capture paranoia typical in the general population, and one pertaining to thought interference common in persecutory delusions in psychosis. RESULTS: Nodes reflecting paranoia in the general population as well as persecution-related concerns in psychosis shared the strongest positive edges with nodes representing threat stemming from close social relationships. Paranoia common in the general population was negatively associated with both safety stemming from the wider social environment, and safety in close relationships, where the former association was strongest. CONCLUSIONS: Our results suggest that threat from within one's immediate social group is more closely linked to paranoid thoughts than is safety from either one's social group or the wider social environment. Further, our results imply that coalitional threat may be a particularly associated with concerns common in psychosis, whereas paranoid ideation more common in the general population is also associated with reduced coalitional safety. Overall, this network analysis offers a broad view of how paranoia relates to multiple aspects of our coalitional environment and provides some testable predictions for future research in this area. PRACTITIONER POINTS: Individuals with paranoia more typical of delusions may find threat in close social relationships most challenging Variation in paranoia in the general population may be attributed to feeling safe in the wider social environment more than in close social relationships.
Assuntos
Transtornos Paranoides , Transtornos Psicóticos , Adulto , Delusões/psicologia , Emoções , Humanos , Relações Interpessoais , Transtornos Paranoides/psicologia , Transtornos Psicóticos/psicologiaRESUMO
Paranoia and suicidality seem to be common traits expressing in the general population to varying degrees. This study aims to explore the association between both and to identify determinants of comorbidity. We interviewed a representative sample of the population in Andalusia (n = 4507) and assessed paranoia and suicidality utilizing the Spanish Green's Paranoid Thoughts Scale (S-GPTS) and the suicidality section of the MINI Neuropsychiatric Interview, respectively. We gathered data on socio-demographics, personality, substance abuse, social support, and environmental distress. We found that paranoia and suicidality were rather common with 6.4% (95% CI: 5.7-7.12) of the sample admitting to some (vs. none) level of suicidality. We also found a robust association between paranoia and suicidality, independent of age and sex (F:298.2; p =.0001; Eta2: .065); 0.5% (95% CI: 0.32-0.76) of the sample (n = 21) presented combinedly high levels of paranoia and some suicidality risk and were considered as having paranoia-suicidality comorbidity (PSC). We identified factors associating with PSC, including poor social support, childhood maltreatment, threatening life-events and increasing personality disorder, and nicotine dependence scores. Paranoia and suicidality are common traits in the general population and their comorbidity seems to associate with low social support, environmental adversity and disordered personality. Suicidality and paranoia are common traits present dimensionally in a representative nonclinical sample. Paranoia strongly and independently associates with suicidality risk in a large population-based study. Paranoia and suicidality comorbidity may be commonly determined by poor social support, disordered personality, previous childhood maltreatment, and exposure to threatening life-events.
Assuntos
Transtornos Paranoides , Suicídio , Estudos Transversais , Humanos , Transtornos Paranoides/epidemiologia , Transtornos Paranoides/psicologia , Transtornos da Personalidade/epidemiologia , Ideação SuicidaRESUMO
Leading theoretical models of psychosis implicate a wide range of psychological factors in the development of positive symptoms. Ambulatory assessment allows us to repeatedly assess people's mental experiences within and across days to explore putative moment-to-moment prospective relationships that impact the onset and exacerbation of positive symptoms. This study used experience sampling methodology to examine the putative temporal associations of both risk and protective factors (negative emotional states, stress, self-esteem, and social appraisals) with the experience of paranoia and other positive psychotic-like experiences (PLE) in daily-life. A combined sample of 178 participants including 65 high-schizotypy, 74 at-risk mental states for psychosis, and 39 first-episode psychosis individuals was assessed repeatedly over seven consecutive days. Sadness, anxiety, stress, and negative social appraisals predicted higher levels of subsequent paranoia and PLE. In contrast, self-esteem and subjective appraisals of social support and social closeness predicted lower levels of paranoia and PLE. Most findings did not vary across subclinical, at-risk, and clinical levels of psychosis expression. Results support psychological models of psychosis and provide new evidence to disentangle psychological factors involved in the mechanistic pathways to positive symptoms. The findings can help the design of ecological momentary interventions delivered in real-time aimed at buffering psychological mechanisms that promote psychotic symptoms and strengthening causal mechanisms that protect from the development of positive symptoms. Finally, findings suggest that highly similar psychological mechanisms are implicated in the development of psychotic experiences across nonclinical, subclinical, and clinical expressions of schizotypy. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
