Hostname: page-component-7dd5485656-dk7s8 Total loading time: 0 Render date: 2025-10-31T08:49:45.544Z Has data issue: false hasContentIssue false
  • English
  • Français

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: tmorrison@manchester.ac.uk)
Get access Rights & Permissions [Opens in a new window]

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

Information

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

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.)

Article purchase

Temporarily unavailable

References

Bentall, RP, Corcoran, R, Howard, R, Blackwood, R, Kinderman, P (2001). Persecutory delusions: a review and theoretical integration. Clinical Psychology Review 22, 1–50.Google Scholar
Bentall, RP, Kaney, S (1996). Abnormalities of self-representation and persecutory delusions. Psychological Medicine 26, 1231–1237.Google Scholar
Bentall, RP, Kinderman, P (2008). The role of self-esteem in paranoid delusions: the psychology, neurophysiology, and development of persecutory beliefs. In Persecutory Delusions: Assessment, Theory and Treatment (ed. Freeman, D., Bentall, R. P. and Garety, P. A.), pp. 145–175. OUP: Oxford.Google Scholar
Bentall, RP, Rowse, G, Shryane, N, Kinderman, P, Howard, 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, 236–247.CrossRefGoogle ScholarPubMed
Cartwright-Hatton, S, Wells, A (2004). A short form of the Metacognitions Questionnaire: properties of the MCQ-30. Behaviour Research and Therapy 42, 385–396.Google Scholar
Chadwick, P, Trower, P, Juusti-Butler, T-M, Maguire, N (2005). Phenomenological evidence for two types of paranoia. Psychopathology 38, 327–333.Google Scholar
Dominguez, M-d-G, Wichers, M, Lieb, R, Wittchen, H-U, van Os, J (2011). Evidence that onset of clinical psychosis is an outcome of progressively more persistent subclinical psychotic experiences: an 8-year cohort study. Schizophrenia Bulletin 37, 84–93.Google Scholar
Fenigstein, A (1984). Self-consciousness and the over-perception of self as a target. Journal of Personality and Social Psychology 47, 860–870.CrossRefGoogle Scholar
Fornells-Ambrojo, M, Garety, PA (2005). Bad me paranoia in early psychosis: a relatively rare phenomenon. British Journal of Clinical Psychology 44, 521–528.CrossRefGoogle ScholarPubMed
Foster, C, Startup, H, Potts, L, 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, 45–51.CrossRefGoogle ScholarPubMed
Fowler, D, Freeman, D, Smith, B, Kuipers, E, Bebbington, P, Bashforth, H, Coker, S, Hodgkins, J, Gracie, A, Dunn, G, Garety, P (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.Google Scholar
Fowler, D, Hodgekins, J, Garety, P, Freeman, D, Kuipers, E, Dunn, G, Smith, B, Bebbington, PE (2012). Negative cognition, depressed mood, and paranoia: a longitudinal pathway analysis using structural equation modeling. Schizophrenia Bulletin 38, 1063–1073.CrossRefGoogle ScholarPubMed
Freeman, D, Dunn, G, Startup, H, Pugh, K, Cordwell, J, Mander, H, Černis, E, Wingham, G, Shirvell, K, Kingdon, D (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. Lancet Psychiatry 2, 305–313.Google Scholar
Freeman, D, Freeman, J, Garety, PA (2006). Overcoming Paranoid and Suspicious Thoughts. Robinson: London.Google Scholar
Freeman, D, Garety, PA (1999). Worry, worry processes and dimensions of delusions: an exploratory investigation of a role for anxiety processes in the maintenance of delusional distress. Behavioural and Cognitive Psychotherapy 27, 47–62.CrossRefGoogle Scholar
Freeman, D, Garety, PA, Bebbington, PE, Smith, B, Rollinson, R, Fowler, D, Kuipers, E, Ray, K, Dunn, G (2005). Psychological investigation of the structure of paranoia in a non-clinical population. British Journal of Psychiatry 186, 427–435.CrossRefGoogle Scholar
Freeman, D, Garety, PA, Kuipers, E, Fowler, D, Bebbington, PE (2002). A cognitive model of persecutory delusions. British Journal of Clinical Psychology 41, 331–347.Google Scholar
Freeman, D, Pugh, K, Antley, A, Slater, M, Bebbington, P, Gittins, M, Dunn, G, Kuipers, E, Fowler, D, Garety, P (2008). Virtual reality study of paranoid thinking in the general population. British Journal of Psychiatry 192, 258–263.CrossRefGoogle ScholarPubMed
Freeman, D, Pugh, K, Dunn, G, Evans, N, Sheaves, B, Waite, F, Černis, E, Lister, R, Fowler, D (2014). An early phase II randomised controlled trial testing the effect on persecutory delusions of using CBT to reduce negative cognitions about the self: the potential benefits of enhancing self confidence. Schizophrenia Research 160, 186–192.Google Scholar
Garety, PA, Kuipers, E, Fowler, D, Freeman, D, Bebbington, PE (2001). A cognitive model of the positive symptoms of psychosis. Psychological Medicine 31, 189–195.Google Scholar
Gumley, AI, Gillan, K, Morrison, AP, Schwannauer, M (2010). The development and validation of the Beliefs about Paranoia Scale (Short Form). Behavioural and Cognitive Psychotherapy 39, 35–53.Google Scholar
Hall, PL, Tarrier, N (2003). The cognitive–behavioural treatment of low self-esteem in psychotic patients: a pilot study. Behaviour Research and Therapy 41, 317–332.CrossRefGoogle ScholarPubMed
Hanssen, M, Bak, M, Bijl, R, Vollebergh, W, van Os, J (2005). The incidence and outcome of subclinical psychotic experiences in the general population. British Journal of Clinical Psychology 44, 181–191.Google Scholar
Huber, PJ (1967). The behavior of maximum likelihood estimates under nonstandard conditions. In Proceedings of the Fifth Berkeley Symposium on Mathematical Statistics and Probability, pp. 221–233. University of California Press: Berkeley, CA.Google Scholar
Laroi, F, van der Linden, M (2005). Metacognitions in proneness towards hallucinations and delusions. Behaviour Research and Therapy 43, 1425–1441.Google Scholar
Lattuada, E, Serretti, A, Cusin, C, Gasperini, M, Smeraldi, E (1999). Symptomatologic analysis of psychotic and non-psychotic depression. Journal of Affective Disorders 54, 183–187.CrossRefGoogle ScholarPubMed
Little, RJA, Rubin, DB (2002). Statistical Analysis with Missing Data. John Wiley and Sons: London.CrossRefGoogle Scholar
Loewy, RL, Johnson, JK, Cannon, TD (2007). Self-report of attenuated psychotic experiences in a college population. Schizophrenia Research 93, 144–151.Google Scholar
Maas, CJM, Hox, JJ (2004). The influence of violations of assumptions on multilevel parameter estimates and their standard errors. Computational Statistics and Data Analysis 46, 427–440.CrossRefGoogle Scholar
Mattick, RP, Clarke, JC (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy 36, 455–470.Google Scholar
Melo, S, Corcoran, R, Shryane, N, Bentall, RP (2009). The Persecution and Deservedness Scale. Psychology and Psychotherapy: Theory, Research and Practice 82, 247–260.CrossRefGoogle ScholarPubMed
Melo, SS, Taylor, JL, Bentall, RP (2006). Poor me versus bad me paranoia and the instability of persecutory ideation. Psychology and Psychotherapy: Theory, Research and Practice 79, 271–287.CrossRefGoogle ScholarPubMed
Morrison, AP (2001). The interpretation of intrusions in psychosis: an integrative cognitive approach to hallucinations and delusions. Behavioural and Cognitive Psychotherapy 29, 257–276.Google Scholar
Morrison, AP, French, P, Stewart, S, Birchwood, M, Fowler, D, Gumley, AI, Jones, PB, Bentall, RP, Lewis, SW, Murray, G, Patterson, P, Brunet, K, Conroy, J, Parker, S, Reilly, T, Byrne, RE, Davies, L, Dunn, G (2012). Early Detection and Intervention Evaluation for people at risk of psychosis (EDIE-2): a multisite randomised controlled trial of cognitive therapy for at risk mental states. British Medical Journal 344, e2233.Google Scholar
Morrison, AP, Gumley, AI, Ashcroft, K, Manousos, R, White, R, Gillan, K, Wells, A, Kingdon, D (2011). Metacognition and persecutory delusions: tests of a metacognitive model in a clinical population and comparisons with non-patients. British Journal of Clinical Psychology 50, 223–233.CrossRefGoogle Scholar
Morrison, AP, Gumley, AI, Schwannauer, M, Campbell, M, Gleeson, A, Griffin, E, Gillan, K (2005). The Beliefs About Paranoia Scale: preliminary validation of a metacognitive approach to conceptualising paranoia. Behavioural and Cognitive Psychotherapy 33, 153–164.Google Scholar
Morrison, AP, Pyle, M, Chapman, N, French, P, Parker, SK, Wells, A (2014). Metacognitive therapy in people with a schizophrenia spectrum diagnosis and medication resistant symptoms: a feasibility study. Journal of Behavior Therapy and Experimental Psychiatry 45, 280–284.Google Scholar
Morrison, AP, Wells, A (2003). Metacognition across disorders: a comparison of patients with hallucinations, delusions, and panic disorder with non-patients. Behaviour Research and Therapy 41, 251–256.CrossRefGoogle Scholar
Morrison, AP, 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.Google Scholar
Moutoussis, M, Williams, J, Dayan, P, Bentall, RP (2007). Persecutory delusions and the conditioned avoidance paradigm: towards an integration of the psychology and biology of paranoia. Cognitive Neuropsychiatry 12, 495–510.Google Scholar
Rabe-Hesketh, S, Skrondal, A, Pickles, A (2002). Reliable estimation of generalized linear mixed models using adaptive quadrature. Stata Journal 2, 1–21.Google Scholar
Smith, B, Fowler, D, Freeman, D, Bebbington, P, Bashforth, H, Garety, P, Kuipers, E, Dunn, G (2006). Emotion and psychosis: direct links between schematic beliefs, emotion and delusions and hallucinations. Schizophrenia Research 86, 181–188.Google Scholar
Snijders, TAB, Bosker, R (1999). Multilevel Analysis: an Introduction to Basic and Advanced Multilevel Modelling. Sage: London.Google Scholar
StataCorp (2009). Stata Statistical Software: Release 11. StataCorp LP: College Station, TX.Google Scholar
Thewissen, V, Bentall, RP, Lecomte, T, van Os, J, Myin-Germeys, I (2008). Fluctuations in self-esteem and paranoia in the context of everyday life. Journal of Abnormal Psychology 117, 143–153.Google Scholar
Trower, P, Chadwick, P (1995). Pathways to defense of the self: a theory of two types of paranoia. Clinical Psychology: Science and Practice 2, 263–278.Google Scholar
Udachina, A, Varese, F, Oorschot, M, Myin-Germeys, I, Bentall, RP (2012). Dynamics of self-esteem in “poor-me” and “bad-me” paranoia. Journal of Nervous and Mental Disease 200, 777–783.Google Scholar
Valiente, C, Prados, JM, Gómez, M, Fuentenebro, F (2012). Metacognitive beliefs and psychological well-being in paranoia and depression. Cognitive Neuropsychiatry 17, 527–543.Google Scholar
van Os, J, Kapur, S (2009). Schizophrenia. Lancet 374, 635–645.Google Scholar
van Os, J, Linscott, RJ, 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, 179–195.CrossRefGoogle ScholarPubMed
van Rossum, I, Dominguez, M-d-G, Lieb, R, Wittchen, H-U, van Os, J (2011). Affective dysregulation and reality distortion: a 10-year prospective study of their association and clinical relevance. Schizophrenia Bulletin 37, 561–571.Google Scholar
Varghese, D, Scott, J, Welham, J, Bor, W, Najman, J, O'Callaghan, M, Williams, G, McGrath, J (2011). Psychotic-like experiences in major depression and anxiety disorders: a population-based survey in young adults. Schizophrenia Bulletin 37, 389–393.Google Scholar
Wells, A, Matthews, G (1994). Attention and Emotion: a Clinical Perspective. LEA: London.Google Scholar
White, H (1980). A heteroskedasticity-consistent covariance matrix estimator and a direct test for heteroskedasticity. Econometrica 48, 817–830.Google Scholar
Winter, LB, Steer, R, Jones-Hicks, L, Beck, AT (1999). Screening for major depressive disorder in adolescent medical outpatients with the Beck Depression Inventory for Primary Care. Journal of Adolescent Health 24, 389–394.CrossRefGoogle Scholar
Yung, A, McGorry, PD, McFarlane, CA, Jackson, H, Patton, GC, Rakkar, A (1996). Monitoring and care of young people at incipient risk of psychosis. Schizophrenia Bulletin 22, 283–303.Google Scholar
Yung, AR, Yuen, HP, McGorry, PD, Phillips, LJ, Kelly, D, Dell'Olio, M, Francey, S, Cosgrave, E, Killackey, E, Stanford, C, Godfrey, K, Buckby, J (2005). Mapping the onset of psychosis – the Comprehensive Assessment of At Risk Mental States (CAARMS). Australian and New Zealand Journal of Psychiatry 39, 964–971.Google Scholar