Cognitive therapy for punishment paranoia: a single case experiment (original) (raw)
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Current Paranoid Thinking in Patients With Delusions: The Presence of Cognitive-Affective Biases
Schizophrenia Bulletin, 2013
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 selfconsciousness 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 emotionrelated 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.
The Cognitive and Affective Structure of Paranoid Delusions
Archives of General Psychiatry, 2009
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.
Psychiatry Research, 2011
The hypothesis that persecutory delusions function to enhance self-esteem implies that patients will show normal explicit, but low implicit self-esteem. As evidence for this has been inconsistent, our study assessed delusional state, explicit and implicit self-esteem and depression in a large sample (n = 139) of schizophrenia patients with acute persecutory delusions (n = 28), patients with remitted persecutory delusions (n = 31), healthy controls (n = 59), and depressed controls (n = 21). Patients with delusions and patients with depression both showed decreased levels of explicit, but normal levels of implicit self-esteem when compared to healthy controls. The direct comparison of levels of explicit and implicit self-esteem within each group revealed that healthy controls had higher explicit than implicit self-esteem, while the converse pattern was found for depressed controls. No discrepancy between explicit and implicit self-esteem was found for acute deluded or remitted patients with schizophrenia. Although these findings do not support the hypothesis that delusions serve to enhance self-esteem, they underline the relevance of low self-esteem in patients with persecutory delusions and point to the necessity of enhancing self-esteem in therapy.
Clinical Psychology & Psychotherapy, 2003
This study is a contribution to the investigation of the active ingredient in psychological therapy for psychosis. Five people with chronic delusions were treated using a single-case experiment design. The treatment was broken down into components that were administered sequentially. A baseline phase was followed by three different treatment conditions (An A-B-C-D design). The treatments were (1) Solution-focused Therapy (2) Schema-focused cognitive therapy (3) Cognitive therapy focused on modification of the delusion. Three of the five clients responded to treatment with a large change in degree of belief in their delusion. Two clients improved during solutionfocused therapy, one client improved during cognitive challenging of the delusion and one client changed during baseline. The implications of this study are discussed.
The self, attributional processes and abnormal beliefs: Towards a model of persecutory delusions
Behaviour Research and Therapy, 1994
In this paper we review a series of recent investigations into cognitive abnormalities associated with persecutory delusions. Studies indicate that persecutory delusions are associated with abnormal attention to threat-related stimuli, an explanatory bias towards attributing negative outcomes to external causes and biases in information processing relating to the self-concept. We propose an integrative model to account for these findings in which it is hypothesized that, in deluded patients, activation of self/ideal discrepancies by threat-related information triggers defensive explanatory biases, which have the function of reducing the self/ideal discrepancies but result in persecutory ideation. We conclude by discussing the implications of this model for the cognitive-behavioural treatment of paranoid delusions.
Paranoia, persecutory delusions and attributional biases
An influential model of persecutory delusions put forward by Bentall and colleagues hypothesizes that persecutory-deluded patients avoid the activation of negative self-beliefs by making externalising, personalising attributions for negative events. The first study reported here used a new instrument for the measurement of persecutory ideation, the Paranoid, Persecutory and Delusion-Proneness Questionnaire, to investigate whether attributional biases are associated with subclinical persecutory ideation. The second study extended this investigation by re-examining associations between attributional biases and persecutory delusions. Both studies used the Internal, Personal and Situational Attributions Questionnaire to measure attributional style. No evidence was found for a connection between attributional biases and subclinical persecutory ideation. Furthermore, there was no support for an association between persecutory delusions and an externalising bias, and only marginal support for the hypothesized relationship between persecutory delusions and a personalising bias. These results suggest that the putative link between persecutory ideation and attributional biases only manifests (if at all) when persecutory ideation is of delusional intensity, and that it is confined to a personalising bias. D
Paranoid Delusions in Schizophrenia Spectrum Disorders and Depression
The Journal of Nervous and Mental Disease, 2008
We aimed to identify transdiagnostic psychological processes associated with persecutory delusions. 68 schizophrenia patients, 47 depressed patients and 33 controls were assessed for paranoia, positive and negative self-esteem, estimations of the frequency of negative, neutral and positive events occurring to the self in the past and in the future and similar estimates for events affecting others in the future.
Schizophrenia Research, 2014
Background: Research has shown that paranoia may directly build on negative ideas about the self. Feeling inferior can lead to ideas of vulnerability. The clinical prediction is that decreasing negative self cognitions will reduce paranoia. Method: Thirty patients with persistent persecutory delusions were randomised to receive brief CBT in addition to standard care or to standard care (ISRCTN06118265). The six session intervention was designed to decrease negative, and increase positive, self cognitions. Assessments at baseline, 8 weeks (posttreatment) and 12 weeks were carried out by a rater blind to allocation. The primary outcomes were posttreatment scores for negative self beliefs and paranoia. Secondary outcomes were psychological well-being, positive beliefs about the self, persecutory delusions, social comparison, self-esteem, anxiety, and depression. Results: Trial recruitment and retention were feasible and the intervention highly acceptable to the patients. All patients provided follow-up data. Posttreatment there was a small reduction in negative self beliefs (Cohen's d = 0.24) and a moderate reduction in paranoia (d = 0.59), but these were not statistically significant. There were statistically significant improvements in psychological well-being (d = 1.16), positive beliefs about the self (d = 1.00), negative social comparison (d = 0.88), self-esteem (d = 0.62), and depression (d = 0.68). No improvements were maintained. No adverse events were associated with the intervention. Conclusions: The intervention produced short-term gains consistent with the prediction that improving cognitions about the self will reduce persecutory delusions. The improvement in psychological well-being is important in its own right. We recommend that the different elements of the intervention are tested separately and that the treatment is lengthened.