Abstract
These two personal accounts contain key aspects of paranoia: the individuals are making judgements about other people; the decision-making is influenced by fear, worry, and unusual ‘feelings’; and danger is anticipated. This is consistent with an emerging body of psychological research that implicates – in the context of the social world – reasoning processes, negative affect, and anomalous internal experiences in the occurrence of delusions. In this chapter the advances in the cognitive and social understanding of psychosis will be illustrated with reference to the clinically important experience of persecutory delusions, where arguably the progress has been most rapid. The initial application of this theoretical knowledge to clinical practice via an interventionist causal model approach will be described.
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In general I’m paranoid about almost everything. Every nice compliment or comment I get given I take it as sarcasm, or I think the person will go away and laugh at me behind my back. Or sometimes if I walk over to people and they snigger or jerk a bit, I get worried they’re plotting against me. I get worried about going to the shop, being followed. When I walk past people, I always get the feeling they’re watching my back. Or they will throw something at me.
Ryan
I feel as if people that are close to me are trying to poison me, and every time I go to dinner they are giving me more of the poison and soon it will kill me. I know they wouldn’t do it but the feeling is so strong that I feel as if they are. I even feel dizzy whilst eating the food and thinking of the poison. I can’t be at home on my own as I feel scared that a ghost, an object or a person is going to kill me. I feel as if someone is going to break into my place and stab me. I feel a horrible feeling in my back where I am going to be stabbed, I hear voices telling me I ain’t worth nothing, they tell me people are going to die.
Katherine
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Bassett, M., Sperlinger, D., & Freeman, D. (2009). Fear of madness and persecutory delusions. Psychosis, 1, 39–50.
Bell, V., Halligan, P.W., & Ellis, H.D. (2006). The Cardiff Anomalous Perceptions Scale (CAPS). Schizophrenia Bulletin, 32, 366–377.
Bentall, R. P., Corcoran, R., Howard, R., Blackwood, N., & Kinderman, P. (2001). Persecutory delusions: A review and theoretical interpretation. Clinical Psychology Review, 21, 1143–1192.
Bentall, R. P., Kinderman, P., & Moutoussis, M. (2008). The role of self-esteem in paranoid delusions: the psychology, neurophysiology, and development of persecutory beliefs. In D. Freeman, R. Bentall & P. Garety (Eds.), Persecutory delusions (pp. 143–173). Oxford: Oxford University Press.
Bentall, R. P., Rowse, G., Kinderman, P., Blackwood, N., Howard, R., Moore, R., et al. (2008). Paranoid delusions in schizophrenia spectrum disorders and depression: the transdiagnostic role of expectations of negative events and negative self-esteem. Journal of Nervous & Mental Disease, 196, 375–383.
Bentall, R. P., Rowse, G., Shryane, N. M., Kinderman, P., Haward, R., Blackwood, N., Moore, R., Corcoran, R. (2009). The cognitive and affective structure of paranoid delusions: A transdiagnostic investigation of patients with schizophrenia spectrum disorders and depression. Archives of General Psychiatry, 66(3), 236–247.
Borkovec, T. D., Ray W. J., & Stober, J. (1998). Worry: a cognitive phenomenon intimately linked to affective, physiological, and interpersonal behavioural processes. Cognitive Therapy and Research, 22, 561–576.
Broome, M. R., Johns, L. C., Valli, I., Woolley, J. B., Tabraham, P., Brett, C., et al. (2007). Delusion formation and reasoning biases in those at clinical high risk for psychosis. British Journal of Psychiatry, 191, s38–s42.
Brüne, M. (2005). “Theory of Mind” in schizophrenia. Schizophrenia Bulletin, 31, 21–42.
Bunney, W. E., Hetrick, W. P., Bunney, B. G., Patterson, J. V., Jin, Y., Potkin, S. G., et al. (1999). Structured interview for assessing perceptual anomalies (SIAPA). Schizophrenia Bulletin, 25, 577–592.
Butler, P. D., & Javitt, D. C. (2005). Early-stage visual processing deficits in schizophrenia. Current Opinion in Psychiatry, 18, 151–157.
Chapman, L. J., & Chapman, J. P. (1980). Scales for rating psychotic and psychotic-like experiences as continua. Schizophrenia Bulletin, 6, 476–489.
Chapman, L. J., Chapman, J. P., Kwapil, T. R., Eckbald, M., & Zinser, M. C. (1994). Putatively psychosis-prone subjects 10 years later. Journal of Abnormal Psychology, 103, 171–183.
Claridge, G. (1997). Theoretical background and issues. In G. Claridge (Eds.), Schizotypy: Implications for illness and health (pp. 3–18). Oxford: Oxford University Press.
Combs, D. R., Penn, D. L., Wicher, M., & Waldheter, E. (2007). The Ambiguous Intentions Hostility Questionnaire (AIHQ): A new measure for evaluating attributional biases in paranoia. Cognitive Neuropsychiatry, 12, 128–143.
Docherty, J. P., Van Kammen, D. P., Siris, S. G., & Marder, S. R. (1978). Stages of onset of schizophrenic psychosis.American Journal of Psychiatry, 135, 420–426.
Dugas, M. J., & Ladouceur, R. (1998). Analysis and treatment of generalised anxiety disorder: A preliminary test of a conceptual model. Behaviour Research and Therapy, 36, 215–226.
Ellett, L., Freeman, D., & Garety, P. A. (2008). The psychological effect of an urban environment on individuals with persecutory delusions: The Camberwell walk study. Schizophrenia Research, 99, 77–84.
Eysenck, M. W., & Van Berkum, J. (1992). Trait anxiety, defensiveness, and the structure of worry. Personality and Individual Differences, 13, 1285–1290.
Foster, C., Startup, H., Potts, L., & Freeman, D. (2009). A randomised controlled trial of a worry intervention for individuals with persistent persecutory delusions. Journal of Behavior Therapy and Experimental Psychiatry, in press.
Fowler, D., Freeman, D., Smith, B., Kuipers, E., Bebbington, P., Bashforth, H., et al. (2006). The Brief Core Schema Scales (BCSS): Psychometric properties and associations with paranoia and grandiosity in non-clinical and psychosis samples. Psychological Medicine, 36, 749–759.
Freeman, D. (2008a). The assessment of persecutory ideation. In D. Freeman, R. Bentall, & P. Garety (Eds.), Persecutory delusions (pp 23–52). Oxford: Oxford University Press.
Freeman, D. (2008b). Studying and treating schizophrenia using virtual reality (vr): A new paradigm. Schizophrenia Bulletin, 34, 605–610.
Freeman, D. (2007). Suspicious minds: The psychology of persecutory delusions. Clinical Psychology Review, 27, 425–457.
Freeman, D., Dunn, G., Garety, P.A., Bebbington, P., Slater, M., Kuipers, E., et al. (2005). The psychology of persecutory ideation I: A questionnaire study. Journal of Nervous and Mental Disease, 193, 302–308.
Freeman, D., & Fowler, D. (2009). Routes to psychotic symptoms: Trauma, anxiety and psychosis-like experiences. Psychiatry Research, 169(2), 107–112.
Freeman, D., & Freeman, J. (2008). Paranoia: The 21st century fear. Oxford: Oxford University Press.
Freeman, D., Freeman, J., & Garety, P. (2006). Overcoming paranoid and suspicious thoughts. London: Robinson.
Freeman, D., & Garety, P.A. (1999). Worry, worry processes and dimensions of delusions: An exploratory investigation of a role for anxiety processes in the maintenance of delusional distress. Behavioural & Cognitive Psychotherapy, 27, 47–62.
Freeman, D., & Garety, P.A. (2000). Comments on the content of persecutory delusions: Does the definition need clarification? British Journal of Clinical Psychology, 39, 407–414.
Freeman, D., Garety, P. A., Bebbington, P., Slater, M., Kuipers, E., Fowler, D., et al. (2005). The psychology of persecutory ideation II: A virtual reality experimental study. Journal of Nervous and Mental Disease, 193, 309–315.
Freeman, D., Garety, P. A., Bebbington, P. E., Smith, B., Rollinson, R., Fowler, D., et al. (2005). Psychological investigation of the structure of paranoia in a non-clinical population. British Journal of Psychiatry, 186, 427–435.
Freeman, D., Garety, P. A., Fowler, D., Kuipers, E., Bebbington, P., Dunn, G. (2004). Why do people with delusions fail to choose more realistic explanations for their experiences? An empirical investigation. Journal of Consulting and Clinical Psychology, 72, 671–680.
Freeman, D., Garety, P. A., & Kuipers, E. (2001). Persecutory delusions: developing the understanding of belief maintenance and emotional distress. Psychological Medicine, 31, 1293–1306.
Freeman, D., Garety, P. A., Kuipers, E., Fowler, D., & Bebbington, P.E. (2002). A cognitive model of persecutory delusions. British Journal of Clinical Psychology, 41, 331–347.
Freeman, D., Garety, P. A., McGuire, P., & Kuipers, E., (2005). Developing a theoretical understanding of therapy techniques: reasoning, therapy and symptoms. British Journal of Clinical Psychology, 44, 241–254
Freeman, D., Gittins, M., Pugh, K., Antley, A., Slater, M., & Dunn, G. (2008). What makes one person paranoid and another person anxious? The differential prediction of social anxiety and persecutory ideation in an experimental situation. Psychological Medicine, 38, 1121–1132.
Freeman, D., Pugh, K., Antley, A., Slater, M., Bebbington, P., Gittins, M., et al. (2008). A virtual reality study of paranoid thinking in the general population. British Journal of Psychiatry, 192, 258–263.
Freeman, D., Pugh, K., & Garety, P. (2008). Jumping to conclusions and paranoid ideation in the general population. Schizophrenia Research, 102, 254–260.
Freeman, D., Pugh, K., Green, C., Valmaggia, L., Dunn, G., & Garety, P. (2007). A measure of state persecutory ideation for experimental studies. Journal of Nervous and Mental Disease, 195, 781–784.
Freeman, D., Pugh, K., Vorontsova, N., Antley, A., & Slater, M. (2009). Establishing the continuum of delusional beliefs. Journal of Abnormal Psychology, in press.
Freeman, D., Pugh, K., Vorontsova, N., & Southgate, L. (2009). Insomnia and paranoia. Schizophrenia Research, 108(1–3), 280–284.
Freeman, D., Slater, M., Bebbington, P.E., Garety, P.A., Kuipers, E., Fowler, D., et al. (2003). Can virtual reality be used to investigate persecutory ideation? The Journal of Nervous and Mental Disease, 191, 509–514.
Frith, C. D. (1992). The cognitive neuropsychology of schizophrenia. Hove: LEA.
Frith, C. D. (2004). Schizophrenia and theory of mind. Psychological Medicine, 34, 385–389.
Garety, P. A. (1985). Delusions: Problems in definition and measurement.British Journal of Medical Psychology, 58, 25–34.
Garety, P. A., Everitt, B. S., & Hemsley, D. R. (1988). The characteristics of delusions. European Archives of Psychiatry and Neurological Sciences, 237, 112–114.
Garety, P. A., & Freeman, D. (1999). Cognitive approaches to delusions: a critical review of theories and evidence. British Journal of Clinical Psychology, 38, 113–154.
Garety, P.A., Freeman, D., Jolley, S., Dunn, G., Bebbington, P.E., Fowler, D., et al. (2005). Reasoning, emotions and delusional conviction in psychosis. Journal of Abnormal Psychology, 114, 373–384.
Glaser, J. P., van Os, J., Portegijs, P. J. M., & Myin-Germeys, I. (2006). Childhood trauma and emotional reactivity to daily life stress in adult frequent attenders of the General Practitioner. Journal of Psychosomatic Research, 61, 229–236.
Gracie, A., Freeman, D., Green, S., Garety, P. A., Kuipers, E., Hardy, A., et al. (2007). The association between traumatic experience, paranoia and hallucinations: A test of the predictions of psychological models. Acta Psychiatrica Scandinavica, 116, 280–289.
Greig, T. C., Bryson, G. J., & Bell, M. D. (2004). Theory of mind performance in schizophrenia. The Journal of Nervous and Mental Disease, 192, 12–18.
Guillem, F., Pampoulova, T., Stip, E., Lalonde, P., & Todorov, C. (2005). The relationships between symptom dimensions and dysphoria in schizophrenia. Schizophrenia Research, 75, 83–96.
Harrington, L., Siegert, R. J., & McClure, J. (2005). Theory of mind in schizophrenia. Cognitive Neuropsychiatry, 10, 249–286.
Harrow, M., Jobe, T. M., & Astrachan-Fletcher, E. B. (2008). Prognosis of persecutory delusions in schizophrenia: a 20-year longitudinal study. In D. Freeman, R. Bentall, & P. Garety (Eds.), Persecutory delusions (pp. 73–90). Oxford: Oxford University Press.
Harrow, M., Rattenbury, F., & Stoll, F. (1988). Schizophrenic delusions: an analysis of their persistence, of related premorbid ideas, and of three major dimensions. In T. F. Oltmanns & B. A. Maher (Eds.), Delusional beliefs (pp. 184–211). New York: Wiley.
Henquet, C., Di Forti, M., Murray, R. M., & van Os, J. (2008). The role of cannabis in inducing paranoia and psychosis. In D. Freeman, R. Bentall, & P. Garety (Eds.), Persecutory delusions (pp. 267–280). Oxford: Oxford University Press.
Hemsley, D. R. (1994). Perceptual and cognitive abnormalities as the bases for schizophrenic symptoms. In A. S. David & J. C. Cutting (Eds.), The neuropsychology of schizophrenia (pp. 97–116). Hove: Erlbaum.
Janssen, I., Krabbendam, L., Bak, M., Hanssen, M., Vollebergh, W, de Graaf, R., et al. (2004). Childhood abuse as a risk factor for psychotic experiences. Acta Psychiatrica Scandinavica, 109, 38–45.
Janssen, I., Versmissen, D., a Campo, J., Myin-germeys, I., van Os, J., & Krabbendam, L. (2006). Attribution style and psychosis. Psychological Medicine, 36, 771–778.
Johns, L. C., Cannon, M., Singleton, N., Murray, R. M., Farrell, M., Brugha, T., et al. (2004). The prevalence and correlates of self-reported psychotic symptoms in the British population. British Journal of Psychiatry, 185, 298–305.
Kapur, S. (2003). Psychosis as a state of aberrant salience: A framework linking biology, phenomenology, and pharmacology. American Journal of Psychiatry, 160, 13–23.
Kapur, S., Mizrahi, R., & Li, M. (2005). From dopamine to salience to psychosis – linking biology, pharmacology and phenomenology of psychosis. Schizophrenia Research, 79, 59-68.
Kendler, K. S., Glazer, W. M., & Morgenstern, H. (1983). Dimensions of delusional experience. American Journal of Psychiatry, 140, 466–469.
Kendler, K. S., Campbell, J. (2009). Interventionist causal models in psychiatry: repositioning the mind-body problem. Psychological Medicine, 39(6), 881–887.
Kirkbride, J. B., Fearon, P., Morgan, C., Dazzan, P., Morgan, K., Tarrant, J., et al. (2006). Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes. Archives of General Psychiatry, 63, 250–258.
Krabbendam, L., Janssen, I., Bijl, R. V., Vollebergh, W. A. M., & van Os, J. (2002). Neuroticism and low self-esteem as risk factors for psychosis. Social Psychiatry and Psychiatric Epidemiology, 37, 1–6.
Langdon, R., Ward, P. B., & Coltheart, M. (in press). Reasoning anomalies associated with delusions in schizophrenia. Schizophrenia Bulletin.
Larkin, W., & Morrison, A. (Eds.). (2006). Trauma and psychosis. Hove, East Sussex: Routledge.
Lemert, E. M. (1962). Paranoia and the dynamics of exclusion. Sociometry, 25, 2–20.
Lyon, H. M., Kaney, S., & Bentall, R. P. (1994). The defensive function of persecutory delusions: evidence from attribution tasks. British Journal of Psychiatry, 164, 637–646.
Maher, B. A. (1974). Delusional thinking and perceptual disorder. Journal of Individual Psychology, 30, 98–113.
Marcelis, M., Navarro-Mateu, F., Murray, R., Selten, J. P., & van Os, J. (1998). Urbanisation and psychosis. Psychological Medicine, 28, 871–879.
Maric, N., Myin-Germeys, I., Delespaul, P., de Graaf, R., Vollebergh, W., Van Os, J. (2004). Is our concept of schizophrenia influenced by Berkson’s bias? Social Psychiatry and Psychiatric Epidemiology, 39(8), 600–605.
Martin, J. A., & Penn, D. L. (2001). Brief report: social cognition and subclinical paranoid ideation. British Journal of Clinical Psychology, 40, 261–265.
Martin, J. A., & Penn, D. L. (2002). Attributional style in schizophrenia. Schizophrenia Bulletin, 28, 131–141.
McGhie, A., & Chapman, J. (1961). Disorders of attention and perception in early schizophrenia. British Journal of Medical Psychology, 34, 103–116.
McGrath, J. J. (2007). The surprisingly rich contours of schizophrenia epidemiology. Archives of General Psychiatry, 64, 14–16.
Mizrahi, R., Kiang, M., Mamo, D. C., Arenovich, T., Bagby, R. M., Zipursky, R. B., et al. (2006). The selective effect of antipsychotics on the different dimensions of the experience of psychosis in schizophrenia spectrum disorders. Schizophrenia Research, 88, 111–118.
Moritz, S., Woodward, T., & Lambert, M. (2007). Under what circumstances do patients with schizophrenia jump to conclusions? A liberal acceptance account. British Journal of Clinical Psychology, 46, 12–13.
Morrison, A. P., & Wells, A. (2007). Relationships between worry, psychotic experiences and emotional distress in patients with schizophrenia spectrum diagnoses and comparisons with anxious and non-patient groups. Behaviour Research and Therapy, 45, 1593–1600.
Myin-Germeys, I., Krabbendam, L., & van Os, J. (2003). Continuity of psychotic symptoms in the community. Current Opinion in Psychiatry, 16, 443–449.
Myin-Germeys, I., & van Os, J. (2007). Stress-reactivity in psychosis: evidence for an affective pathway to psychosis. Clinical Psychology Review, 27, 409–424.
Norman, R. M., & Malla, A. K. (1994). Correlations over time between dysphoric mood and symptomatology in schizophrenia. Comprehensive Psychiatry, 35, 34–38.
Oltmanns, T. F. (1988). Approaches to the definition and study of delusions. In T. F. Oltmanns & B. A. Maher (Eds.), Delusional beliefs (pp. 3–12). New York: Wiley.
Peralta, V., & Cuesta, M.J. (1998). Factor structure and clinical validity of competing models of positive symptoms in schizophrenia. Biological Psychiatry, 44, 107–114.
Poulton, R., Caspi, A., Moffitt, T. E., Cannon, M., Murray, R., & Harrington, H. (2000). Children’s self-reported psychotic symptoms and adult schizophreniform disorder. Archives of General Psychiatry, 57, 1053–1058.
Sanchez-Vives, M. V., & Slater, M. (2005). From presence to consciousness through Virtual Reality. Nature Reviews Neuroscience, 6, 332–339.
Sarfati, Y., Hardy-Baylé, M., Besche, C., & Widlöcher, D. (1997). Attribution of intentions to others in people with schizophrenia. Schizophrenia Research, 25, 199–209.
Scott, J., Chant, D., Andrews, G., Martin, G., & McGrath, J. (2007). Association between trauma exposure and delusional experiences in a large community-based sample. British Journal of Psychiatry, 190, 339–343.
Smith, B., Fowler, D., Freeman, D., Bebbington, P., Bashforth, H., Garety, P., et al. (2006). Emotion and psychosis: direct links between schematic beliefs, emotion and delusions and hallucinations. Schizophrenia Research, 86, 181–188.
Startup, H., Freeman, D., & Garety, P. A. (2007). Persecutory delusions and catastrophic worry in psychosis: developing the understanding of delusion distress and persistence. Behaviour Research and Therapy, 45, 523–537.
Startup, H., Freeman, D., & Garety, P. (2008). Jumping to conclusions and persecutory delusions. European Psychiatry, 23, 457–459.
Strauss, J. S. (1969). Hallucinations and delusions as points on continua function. Archives of General Psychiatry, 20, 581–586.
Sundquist, K., Frank, G., & Sundquist, J. (2004). Follow-up study of 4.4 million women and men in Sweden. British Journal of Psychiatry, 184, 293–298.
Thewissen, V., Bentall, R. P., Lecomte, T., van Os, J., & Myin-Germeys, I. (2008). Fluctuations in self-esteem and paranoia in the context of daily life. Journal of Abnormal Psychology, 117, 143–153.
Thewissen, V., Myin-Germeys, I., Bentall, R., de Graaf, R., Vollebergh, W., & van Os, J. (2005). Hearing impairment and psychosis revisited. Schizophrenia Research, 76, 99–103.
Trower, P., Birchwood, M., Meaden, A., Byrne, S., Nelson, A., & Ross, K. (2004). Cognitive therapy for command hallucinations. British Journal of Psychiatry, 184, 312-320.
Uhlhaas, P. J., & Mishara, A. L. (2007). Perceptual anomalies in schizophrenia. Schizophrenia Bulletin, 33, 142–156.
Van Dael, F., Versmissen, D., Janssen, I., Myin-Germeys, I., van Os, J., & Krabbendam, L. (2006). Data gathering: biased in psychosis? Schizophrenia Bulletin, 32, 341–351.
Van Os, J. (2004). Does the urban environment cause psychosis? British Journal of Psychiatry, 184, 287–288.
Van Os, J., Hanssen, M., Bijl, R. V., & Ravelli, A. (2000). Strauss (1969) revisited: A psychosis continuum in the general population. Schizophrenia Research, 45, 11-20.
Van Os, J., Linscott, R. J., Myin-Germeys, I., Delespaul, P., & Krabbendam, L. (2009). A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness–persistence–impairment model of psychotic disorder. Psychological Medicine, 39(2), 179–195.
Van Winkel, R., Stefanis, N. C., & Myin-Germeys, I. (2008). Psychosocial stress and psychosis. A review of the neurobiological mechanisms and the evidence for gene-stress interaction. Schizophrenia Bulletin, 34, 1095–1105.
Vázquez-Barquero, J. L., Lastra, I., Nuñez, M. J. C., Castanedo, S. H., & Dunn, G. (1996). Patterns of positive and negative symptoms in first episode schizophrenia. British Journal of Psychiatry, 168, 693–701.
Vermissen, D., Janssen, I., Myin-Germeys, I., Mengelers, R., à Campo, J., van Os, J., et al. (2008). Evidence for a relationship between mentalising deficits and paranoia over the psychosis continuum. Schizophrenia Research, 99, 103–110.
Wells, A. (1994). A multi-dimensional measure of worry: development and preliminary validation of the anxious thoughts inventory. Anxiety, Stress and Coping, 6, 289–299.
Woodward, J. (2003). Making things happen: A theory of causal explanation. New York: Oxford University Press.
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The author is supported by a Wellcome Trust Fellowship.
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Freeman, D. (2010). Cognitive and Social Processes in Psychosis: Recent Developments. In: Gattaz, W., Busatto, G. (eds) Advances in Schizophrenia Research 2009. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-0913-8_15
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