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Negative cognition, affect, metacognition and dimensions of paranoia in people at ultra-high risk of psychosis: a multi-level modelling analysis

Published online by Cambridge University Press:  13 July 2015

A. P. Morrison ,
N. Shryane ,
D. Fowler ,
M. Birchwood ,
A. I. Gumley ,
H. E. Taylor ,
P. French ,
S. L. K. Stewart ,
P. B. Jones  and
S. W. Lewis
...Show all authors
A. P. Morrison*
Affiliation:
School of Psychological Sciences, University of Manchester, Manchester, UK Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
N. Shryane
Affiliation:
Institute for Social Change, University of Manchester, Manchester, UK
D. Fowler
Affiliation:
School of Medicine, Health Policy, and Practice, University of East Anglia, Norwich, UK
M. Birchwood
Affiliation:
School of Psychology, University of Birmingham, Birmingham, UK
A. I. Gumley
Affiliation:
Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
H. E. Taylor
Affiliation:
School of Psychological Sciences, University of Manchester, Manchester, UK
P. French
Affiliation:
School of Psychological Sciences, University of Manchester, Manchester, UK Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
S. L. K. Stewart
Affiliation:
Department of Psychology, University of Chester, Chester, UK
P. B. Jones
Affiliation:
Department of Psychiatry, University of Cambridge, Cambridge, UK
S. W. Lewis
Affiliation:
Institute for Brain, Behaviour and Mental Health, School of Medicine, University of Manchester, Manchester, UK
R. P. Bentall
Affiliation:
Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
*
* Address for correspondence: A. P. Morrison, School of Psychological Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK. (Email: [email protected])
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Abstract

Background

Paranoia is one of the commonest symptoms of psychosis but has rarely been studied in a population at risk of developing psychosis. Based on existing theoretical models, including the proposed distinction between ‘poor me’ and ‘bad me’ paranoia, we aimed to test specific predictions about associations between negative cognition, metacognitive beliefs and negative emotions and paranoid ideation and the belief that persecution is deserved (deservedness).

Method

We used data from 117 participants from the Early Detection and Intervention Evaluation for people at risk of psychosis (EDIE-2) trial of cognitive–behaviour therapy, comparing them with samples of psychiatric in-patients and healthy students from a previous study. Multi-level modelling was utilized to examine predictors of both paranoia and deservedness, with post-hoc planned comparisons conducted to test whether person-level predictor variables were associated differentially with paranoia or with deservedness.

Results

Our sample of at-risk mental state participants was not as paranoid, but reported higher levels of ‘bad-me’ deservedness, compared with psychiatric in-patients. We found several predictors of paranoia and deservedness. Negative beliefs about self were related to deservedness but not paranoia, whereas negative beliefs about others were positively related to paranoia but negatively with deservedness. Both depression and negative metacognitive beliefs about paranoid thinking were specifically related to paranoia but not deservedness.

Conclusions

This study provides evidence for the role of negative cognition, metacognition and negative affect in the development of paranoid beliefs, which has implications for psychological interventions and our understanding of psychosis.

Keywords

At risk mental statecognitive modelsparanoiapsychosis
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 12 , September 2015 , pp. 2675 - 2684
Copyright
Copyright © Cambridge University Press 2015 

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