Friday 13 December 2013

Thinking Style and Threat-related Processing in Paranoia

The Psychosis Research Partnership
We, Professor Philippa Garety, Professor Elizabeth Kuipers, Dr Helen Waller and Dr Amy Hardy, are Research Clinical Psychologists based at the Department of Psychology, Institute of Psychiatry, King’s College London. 
We work with the Psychosis Research Partnership (Professor David Fowler, Professor Paul Bebbington, Professor Daniel Freeman, Dr Richard Emsley & Professor Graham Dunn) on a research programme funded by the Maudsley Charity and the Wellcome Trust. This research has found it is common for people to have thoughts about others intending to cause them harm, which do not seem to be a valid reflection of the shared reality of others. These can range from fleeting ideas that someone on the street might be laughing at us, to more elaborate and persistent beliefs such as that the secret services are trying to have us killed. Most people experience paranoid thoughts occasionally, but for some the preoccupation, distress and conviction related to paranoia increases and it can become a defining part of their life.

Our research group is interested in understanding the psychological factors that contribute to the development and maintenance of these paranoid thoughts, guided by cognitive-behavioural models for emotional disorders. This perspective argues that an individual’s interpretation of an event, rather than the event per se, influences what they think, feel and do in response. In turn, their interpretation is affected by a range of factors: their life history; thinking styles; unusual sensory-perceptual experiences; attentional processes; emotional states, and beliefs about the self, the world, and other people.

The research we have conducted suggests two factors are particularly key in influencing paranoid thoughts. First, the way in which people think. This includes our ability to consider different explanations for events other than a paranoid interpretation, and what and how much information we gather in deciding how to interpret an event. Second, the extent to which we engage in threat-related processing, such as feeling anxious, thinking negatively about ourselves, worrying, being biased to paying attention to danger, believing others are risky, and doing things to protect ourselves. 

When our thoughts, feelings and actions are focused on threat, we are more likely to be paranoid and believe others will cause us harm. For example, Sam believes that people in her area think she is a bad person, and that everywhere she goes people watch and gossip about her. This started after she was made redundant from her job when her company made cutbacks. She thought from the start she would be the one to go because people did not like her, and now thinks that everyone has found out about her being rejected. 

Sam always found it difficult to fit in at work and school, as she often feels anxious and struggles to talk to other people. Sam’s dad used to criticise her, telling her she was “useless” and “no good”, and she was bullied by other children when growing up. Now, when Sam goes out, she feels very on edge, and straight away notices people looking at and talking about her. This makes her feel even more anxious and worried, and so she keeps to herself. She tries not to go out unless she has to, even though she wants to have friends and get back to work. 

Identifying the key processes that contribute to paranoia has helped our team to develop talking treatments to help people like Sam manage the impact it has on their lives. These therapies target the reasoning styles and anxiety processes that we know are critical to paranoid thinking, and we have shown that they can help people feel less distressed and cope better with paranoia. 

An important challenge for cognitive-behavioural therapies for paranoid thinking is to find ways of helping people that they find interesting and enjoyable to do, and are cost effective for mental health services. We believe that new technologies present exciting opportunities for delivering these interventions, and we are currently investigating the feasibility of two brief, computerised interventions (“The Insider’s Guide to Thinking Well” and “Street Smart”) that target how people think about paranoid thoughts and cope with anxiety, to help them manage their fears about others.

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