Insomnia, worry, anxiety and depression as predictors of the occurrence and persistence of paranoid thinking.
ABSTRACT Our theoretical model proposes that insomnia, worry, and negative affect are important determinants of paranoid thinking. Anxiety produces anticipation of threat, depression increases the sense of vulnerability, worry leads to implausible ideas, and insomnia exacerbates negative affect and creates an altered perceptual state. The study objective was to examine for the first time these factors as predictors of the onset of new paranoid thinking and of the persistence of existing paranoid thinking.
A total of 2,382 participants in the 2000 British National Psychiatric Morbidity Survey were followed-up 18 months after their first assessment. Baseline assessments were used to predict the development and persistence of paranoid thinking at follow-up. Data were weighted to be representative of the general household population.
Insomnia, worry, anxiety, depression and depressive ideas were each substantial predictors both of new inceptions of paranoia and of the persistence of existing paranoid thinking. Worry and insomnia were the strongest predictors. For example, insomnia at the first assessment led to a more than threefold increase in later inceptions of paranoid thinking.
The study indicates that insomnia, worry, anxiety and depression are potential risk factors for new inceptions of paranoid thinking. The results also corroborate an emerging literature indicating that anxiety, worry and depression may encourage the persistence of paranoid thinking. The study provides the first longitudinal evidence linking insomnia and paranoia. The important clinical implication is that the use of interventions for common mental health difficulties in people with psychosis may have the additional benefit of reducing paranoia.
- SourceAvailable from: Ken I. Manktelow[Show abstract] [Hide abstract]
ABSTRACT: The threat anticipation model of paranoia (Freeman, 2007) highlights the important roles of schemas and affect in delusional belief; however, we aimed to address unanswered questions about the way in which affect mediates the relationship between schemas and persecutory ideas. In Study 1, we hypothesized that anxiety would mediate the relationship between persecutory ideation (PI) and both negative-self schemas (NSS) and negative-other schemas (NOS). A nonclinical sample completed a battery of measures on computer. Anxiety partially mediated the relationship between NSS and PI, but NOS were related to PI independently of anxiety. In Study 2, an expanded model included self-esteem as a further predictor and social anxiety and depression as additional mediators. A path analysis of the expanded model suggested that the strongest fit reflected pathways from the self-concept (NSS and self-esteem) to PI via the affective variables (social anxiety, anxiety, depression), but with depression being the most important mediator. NOS still showed an independent relationship with PI. The findings suggest 2 pathways to PI: negative-self schemas depend on negative affect (particularly depression) to predict PI; in contrast, strong negative-other schemas may present sufficient foundation for persecutory beliefs regardless of negative affect.10/2014; 46(4):497-505. DOI:10.1037/a0036263
- Canadian Journal of Behavioural Science 06/2014; 46(4):497-505. · 0.46 Impact Factor
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ABSTRACT: Background Being physically assaulted is known to increase the risk of the occurrence of post-traumatic stress disorder (PTSD) symptoms but it may also skew judgements about the intentions of other people. The objectives of the study were to assess paranoia and PTSD after an assault and to test whether theory-derived cognitive factors predicted the persistence of these problems. Method At 4 weeks after hospital attendance due to an assault, 106 people were assessed on multiple symptom measures (including virtual reality) and cognitive factors from models of paranoia and PTSD. The symptom measures were repeated 3 and 6 months later. Results Factor analysis indicated that paranoia and PTSD were distinct experiences, though positively correlated. At 4 weeks, 33% of participants met diagnostic criteria for PTSD, falling to 16% at follow-up. Of the group at the first assessment, 80% reported that since the assault they were excessively fearful of other people, which over time fell to 66%. Almost all the cognitive factors (including information-processing style during the trauma, mental defeat, qualities of unwanted memories, self-blame, negative thoughts about self, worry, safety behaviours, anomalous internal experiences and cognitive inflexibility) predicted later paranoia and PTSD, but there was little evidence of differential prediction. Conclusions Paranoia after an assault may be common and distinguishable from PTSD but predicted by a strikingly similar range of factors.Psychological Medicine 03/2013; 43(12):1-12. DOI:10.1017/S003329171300038X · 5.43 Impact Factor