Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-24T16:12:30.353Z Has data issue: false hasContentIssue false

An Experimental Investigation into the Effect of State-Anxiety on State-Paranoia in People Experiencing Psychosis

Published online by Cambridge University Press:  25 June 2018

Megan Cowles*
Affiliation:
Avon & Wiltshire Mental Health Partnership Trust, Bristol Mental Health, Complex Psychological Interventions, Petherton Resource Centre, Petherton Road, Bristol BS14 9BP
Lorna Hogg
Affiliation:
Department of Psychology, University of Bath, Bath BA2 7AY
*
Correspondence to Megan Cowles, Avon & Wiltshire Mental Health Partnership Trust, Bristol Mental Health, Complex Psychological Interventions, Petherton Resource Centre, Petherton Road, Bristol BS14 9BP. E-mail: [email protected]

Abstract

Background: There is strong evidence to suggest that anxiety is associated with paranoia in clinical and non-clinical samples. However, no research to date has directly manipulated anxiety to investigate if state-anxiety has a causal role in state-paranoia in clinical populations. Aims: To investigate whether an anxious-mood induction leads to greater paranoia than a neutral-mood induction in people experiencing psychosis and paranoia and, if so, whether this is predicted by anxiety over and above other variables. Method: 22 participants with a psychosis-spectrum diagnosis took part in a two condition cross-over experimental design. Participants underwent a neutral-mood and an anxious-mood induction with levels of state-anxiety, state-affect and state-paranoia being measured before and after each condition. Results: State-paranoia was significantly higher after the anxious condition compared with the neutral condition. State-anxiety and negative-affect were significant predictors of levels of state-paranoia after the anxious condition. When both predictors were included in a regression model, only negative-affect was a significant predictor of state-paranoia after the anxious condition. There were a number of methodological limitations. Conclusions: State-anxiety and negative-affect may both be involved in the maintenance of paranoia in clinical populations, as predicted by cognitive models. Negative-affect may be the strongest predictor of state-paranoia in clinical populations. Reasons for this are discussed, as well as the implications. Interventions that seek to reduce negative state-affect may be beneficial in managing state-paranoia. Further research is warranted to explore the suggested clinical and theoretical implications of these findings.

Type
Research Article
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). American Psychiatric Publishing.Google Scholar
Ascone, L., Sundag, J., Schlier, B. and Lincoln, T. M. (2017). Feasibility and effects of a brief compassion-focused imagery intervention in psychotic patients with paranoid ideation: a randomized experimental pilot study. Clinical Psychology and Psychotherapy, 24, 348358. doi:10.1002/cpp.2003Google Scholar
Bebbington, P. E., McBride, O., Steel, C., Kuipers, E., Radovanovic, M., Brugha, T. et al. (2013). The structure of paranoia in the general population. British Journal of Psychiatry, 202, 419427. doi:10.1192/bjp.bp.112.119032Google Scholar
Bosanac, P., Mancuso, S. G. and Castle, D. J. (2016). Anxiety symptoms in psychotic disorders: results from the Second Australian National Mental Health Survey. Clinica Schizophrenia and Related Psychoses, 10, 93100. doi: 10.3371/1935-1232-10.2.93Google Scholar
Butler, G., Fennell, M. and Hackmann, A. (2010). Cognitive-Behavioral Therapy for Anxiety Disorders: Mastering Clinical Challenges (Guides to Individualized Evidence-based Treatment). Guilford Press.Google Scholar
Castilho, P., Pinto, A. M., Viegas, R., Carvalho, S., Madeira, N. and Martins, M. J. (2017). External shame as a mediator between paranoia and social safeness in psychosis. Clinical Psychology. doi: 10.1111/cp.12136Google Scholar
Chadwick, P. D., Birchwood, M. J. and Trower, P. (1996). Cognitive Therapy for Delusions Voices and Paranoia. Oxford, UK: Wiley.Google Scholar
Collett, N. Pugh, K., Waite, F. and Freeman, D. (2016). Negative cognitions about the self in patients with persecutory delusions: an empirical study of self-compassion, self-stigma, schematic beliefs, self-esteem, fear of madness, and suicidal ideation. Psychiatry Research, 239, 7984. https://doi.org/10.1016/j.psychres.2016.02.043Google Scholar
Drake, R., Haddock, G., Tarrier, N., Bentall, R. and Lewis, S. (2007). The Psychotic Symptom Rating Scales (PSYRATS): their usefulness and properties in first episode psychosis. Schizophrenia Research, 89, 119122. doi: 10.1016/j.schres.2006.04.024Google Scholar
Drake, R. J., Pickles, A., Bentall, R. P., Kinderman, P., Haddock, G., Tarrier, N. and Lewis, S. W. (2004). The evolution of insight, paranoia and depression during early schizophrenia. Psychological Medicine, 34, 285292.Google Scholar
Faul, F., Erdfelder, E., Buchner, A. and Lang, A. G. (2009). Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behavior Research Methods, 41, 11491160. doi: 10.3758/brm.41.4.1149Google Scholar
Foster, C., Startup, H., Potts, L. and Freeman, D. (2010). A randomised controlled trial of a worry intervention for individuals with persistent persecutory delusions. Journal of Behavior Therapy and Experimental Psychiatry, 41, 4551. doi: 10.1016/j.jbtep.2009.09.001Google Scholar
Freeman, D. (2007). Suspicious minds: the psychology of persecutory delusions. Clinical Psychology Review, 27, 425457. doi: 10.1016/j.cpr.2006.10.004Google Scholar
Freeman, D., Dunn, G., Startup, H., Pugh, K., Cordwell, J., Mander, H. et al. (2015). Effects of cognitive behaviour therapy for worry on persecutory delusions in patients with psychosis (WIT): a parallel, single-blind, randomised controlled trial with a mediation analysis. The Lancet, 2, 305313. doi: 10.1016/S2215-0366(15)00039-5Google Scholar
Freeman, D. and Garety, P. (2000). Comments on the content of persecutory delusions: does the definition need clarification? British Journal of Clinical Psychology, 39, 407414. doi: 10.1348/014466500163400Google Scholar
Freeman, D. and Garety, P. (2014). Advances in understanding and treating persecutory delusions: a review. Social Psychiatry and Psychiatric Epidemiology, 49, 11791189. doi: 10.1007/s00127-014-0928-7Google Scholar
Freeman, D., Garety, P., Bebbington, P., Smith, B., Rollinson, R., Fowler, D. et al. (2005). Psychological investigation of the structure of paranoia in a non-clinical population. The British Journal of Psychiatry, 186, 427435. doi: 10.1192/bjp.186.5.427Google Scholar
Freeman, D., Garety, P. A., Kuipers, E., Fowler, D. and Bebbington, P. E. (2002). A cognitive model of persecutory delusions. British Journal of Clinical Psychology, 41, 331347.Google Scholar
Freeman, D., McManus, S., Brugha, T., Meltzer, H., Jenkins, R. and Bebbington, P. (2011). Concomitants of paranoia in the general population. Psychological Medicine, 41, 923936. doi: 10.1017/S0033291710001546Google Scholar
Freeman, D., Pugh, K., Vorontsova, N., Antley, A. and Slater, M. (2010). Testing the continuum of delusional beliefs: an experimental study using virtual reality. Journal of Abnormal Psychology, 119, 8392. doi: 10.1037/a0017514Google Scholar
Gilbert, P. (2010). Compassion Focused Therapy. Routledge.Google Scholar
Giusti, L., Ussorio, D., Salza, A., Malavolta, M., Aggio, A., Bianchini, V. et al. (2017). Preliminary study of effects on paranoia ideation and jumping to conclusions in the context of group treatment of anxiety disorders in young people. Early Intervention in Psychiatry, ePud ahead of print. doi: 10.1111/eip.12415Google Scholar
Grezellschak, S., Lincoln, T. M. and Westermann, S. (2015). Cognitive emotion regulation in patients with schizophrenia: evidence for effective reappraisal and distraction. Psychiatry Reserach, 229, 434439. doi: 10.1016/j.psychres.2015.05.103Google Scholar
Haddock, G., McCarron, J., Tarrier, N. and Faragher, E. B. (1999). Scales to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS). Psychological Medicine, 29, 879889.Google Scholar
Hartley, S., Barrowclough, C. and Haddock, G. (2013). Anxiety and depression in psychosis: a systematic review of associations with positive psychotic symptoms. Acta Psychiatrica Scandinavica, 128, 327346. doi: 10.1111/acps.12080Google Scholar
Huppert, J. D. and Smith, T. E. (2005). Anxiety and schizophrenia: the interaction of subtypes of anxiety and psychotic symptoms. CNS Spectrums, 10, 721731.Google Scholar
Johnson, J., Jones, C., Lin, A., Wood, S., Heinze, K. and Jackson, C. (2014). Shame amplifies the association between stressful life events and paranoia amongst young adults using mental health services: implications for understanding risk and psychological resilience. Psychiatry Research, 220, 217225. doi: 10.1016/j.psychres.2014.07.022Google Scholar
Kesting, M. L., Bredenpohl, M., Klenke, J., Westermann, S. and Lincoln, T. M. (2013). The impact of social stress on self-esteem and paranoid ideation. Journal of Behavior Therapy and Experimental Psychiatry, 44, 122128. doi: 10.1016/j.jbtep.2012.07.010Google Scholar
Lincoln, T. M., Hohenhaus, F. and Hartmann, M. (2013). Can paranoid thoughts be reduced by targeting negative emotions and self-esteem? An experimental investigation of a brief compassion-focused Intervention. Cognitive Therapy Research, 37, 390402. doi: 10.1007/s10608-012-9470-7Google Scholar
Lincoln, T. M., Lange, J., Burau, J., Exner, C. and Moritz, S. (2010). The effect of state anxiety on paranoid ideation and jumping to conclusions. An experimental investigation. Schizophrenia Bulletin, 36, 11401148. doi: 10.1093/schbul/sbp029Google Scholar
Lincoln, T. M., Peter, N., Schäfer, M. and Moritz, S. (2009). Impact of stress on paranoia: an experimental investigation of moderators and mediators. Psychological Medicine, 39, 11291139. doi: 10.1017/S0033291708004613Google Scholar
Morrison, A. P. (2001). The interpretation of intrusions in psychosis: an integrative cognitive approach to hallucinations and delusions. Behavioural and Cognitive Psychotherapy, 29, 257276. doi: 10.1017/S1352465801003010Google Scholar
Salokangas, R. K. R., Schultze-Lutter, F., Hietala, J., Heinimaa, M., From, T., Ilonen, T. et al. (2016). Depression predicts persistence of paranoia in clinical high-risk patients to psychosis: results of the EPOS project. Social Psychiatry and Psychiatric Epidemiology, 51, 247257. doi: 10.1007/s00127-015-1160-9Google Scholar
Schlier, B., Moritz, S. and Lincoln, T. M. (2016). Measuring fluctuations in paranoia: validity and psychometric properties of brief state versions of the Paranoia Checklist. Psychiatry Research, 241, 323332. doi: 10.1016/j.psychres.2016.05.002Google Scholar
Stemmler, G., Heldmann, M., Pauls, C. A. and Scherer, T. (2001). Constraints for emotion specificity in fear and anger: the context counts. Psychophysiology, 38, 275291. doi: 10.1111/1469-8986.3820275Google Scholar
Thewissen, V., Bentall, R. P., OorschotM., J, A. C. M., J, A. C., van Lierop, T., van Os, J. and Myin-Germeys, I. (2011). Emotions, self-esteem, and paranoid episodes: an experience sampling study. British Journal of Clinical Psychology, 50, 178195. doi: 10.1348/014466510x508677Google Scholar
Wells, A. (1997). Cognitive Therapy of Anxiety Disorders: A Practice Manual And Conceptual Guide. JW.Google Scholar
Submit a response

Comments

No Comments have been published for this article.