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The psychological effect of an urban environment on individuals with persecutory delusions: The Camberwell Walk Study
Abstract
Epidemiological studies have found that individuals who live in urban areas are at increased risk of developing psychosis. However it is unknown whether exposure to urban environments exacerbates psychotic symptoms in people who have a diagnosed psychotic disorder. The aim of the study was to examine the psychological and clinical effects of exposure to one specific deprived urban environment on individuals with persecutory delusions. It was predicted that the urban environment would affect emotional and reasoning processes highlighted in a cognitive model of persecutory delusions and would increase paranoia.
Thirty patients with persecutory delusions were randomised to exposure to a deprived urban environment or to a brief mindfulness relaxation task. After exposure, assessments of symptoms, reasoning, and affective processes were taken. Thirty matched non-clinical participants also completed the study measures to enable interpretation of the test scores.
In individuals with persecutory delusions, exposure to the urban environment, rather than participation in a mindfulness task, increased levels of anxiety, negative beliefs about others and jumping to conclusions. It also increased paranoia. The individuals with persecutory delusions scored significantly differently from the non-clinical group on all measures.
For individuals with psychosis, spending time in an urban environment makes them think more negatively about other people and increases anxiety and the jumping to conclusions reasoning bias. Their paranoia is also increased. A number of processes hypothesised in cognitive models to lead to paranoid thoughts are exacerbated by a deprived urban environment. Further research is needed to clarify which aspects of urban environments cause the negative effects. Methodological challenges in the research area are raised.
... This suggests that an increase in negative affect could form a pathway through which social exposure in urban environments triggers paranoid thoughts. Similarly, Ellett, Freeman, and Garety (2008) found that going outside (buying newspapers on a busy street) versus performing relaxation tasks indoors led to an increase in paranoia, anxiety, negative beliefs about others, and jumping to conclusions. A possible explanation of how urban environments influence mental health is through social defeat-individuals living in urban areas are exposed to higher levels of social competition, leading to social defeat stress (Selten and Cantor-Graae 2005). ...
... Additionally, participants completed the trustworthiness task in the counterbalanced order (normal vs. noise). Some studies (e.g., Ellett, Freeman, and Garety 2008;Freeman et al. 2015) assessed paranoia in real-world environments containing threats of interpersonal harm, such as exposure to a busy street. We used a sound recording of noise from a busy city street (featuring the sound of traffic, crying, shouting, and indistinguishable babble) at approximately 80 dB, similar to those used by Urbańska, Moritz, and Gawęda (2019), Wright et al. (2014), and Lincoln et al. (2015), presented through headphones to induce psychosocial stress. ...
... For instance, Pinkham, Hopfinger, and Penn (2012) found that individuals with SCZ may perceive faces as less trustworthy when exposed to stress, likely due to the heightened threat sensitivity commonly observed in SCZ. Furthermore, previous studies (Ellett, Freeman, and Garety 2008;Freeman et al. 2015) demonstrated that walking in a busy immersive environment increased paranoia and negative affect. ...
The present study examines the impact of induced social stress on facial trustworthiness judgments in individuals with schizophrenia (SCZ) and the associations between symptoms and trustworthiness ratings. Thirty‐three individuals with SCZ and forty healthy controls (HC) were asked to rate the trustworthiness of 24 digitally morphed faces in two counterbalanced conditions. Mild social stress was induced by listening to loud noises from a busy street. BPRS, CAPE‐42, and the Paranoia Scale measured the severity of symptoms. We did not observe significant differences in trustworthiness judgments between the patient and control groups. Social stress did not impact trust judgments. Paranoia was negatively connected to trustworthiness ratings in the control group. Subjective rating of stress in noise condition was negatively associated with paranoia only in the control sample. In the patient group, a negative correlation was found between trustworthiness ratings in stress conditions and the severity of self‐reported negative symptoms. Our results suggest that mild social stress does not significantly affect trustworthiness judgments in either patients with SCZ or in HC. Differences between the patient and control groups in trustworthiness judgments were negligible. Overall, the results of this study can be considered mainly negative and contrast with previous studies. The stress induction paradigm or a smaller sample size might cause observed results. In controls, biased face perception was linked to trait paranoia. By contrast, in SCZ, other factors might impact trust perception and need further examination.
... A plethora of empirical studies indicate that delusions are exacerbated or aggravated in stressful contexts, both among patients with clinical psychosis (e.g., Ellett, Freeman, & Garety, 2008;Sundag, Ascone, & Lincoln, 2017) and non-clinical delusion-prone individuals (e.g., Kesting, Bredenpohl, Klenke, Westermann, & Lincoln, 2013;Lincoln, Lange, Burau, Exner, & Moritz, 2010). These findings support the core assumptions of vulnerability-stress models of psychosis (Howes & Murray, 2014;Zubin & Spring, 1977). ...
... However, whether the aforementioned biases are exacerbated in the context of exposure to social and/or non-social aspects of environment in vulnerable individuals is unclear at present. To answer this question, previous experimental studies in clinical samples have tended to focus almost exclusively on the JTC bias (Ellett et al., 2008;Moritz et al., 2009;Wright, Peters, Ettinger, Kuipers, & Kumari, 2016) often without concurrent symptom change assessment (Moritz et al., 2009;Wright et al., 2016) and use various stress conditions, thus limiting the possibility of drawing clear conclusions about the causal role of stress in aggravation of different cognitive biases as a potential mechanism of delusional ideation in vulnerable individuals. Most of these studies exposed patients to social stressors, e.g., by immersion into virtual reality social environments (Pot-Kolder, Veling, Counotte, & van der Gaag, 2018) or by taking notes on their behaviour and announcing video-recording of short speech at the end of condition . ...
... Most of these studies exposed patients to social stressors, e.g., by immersion into virtual reality social environments (Pot-Kolder, Veling, Counotte, & van der Gaag, 2018) or by taking notes on their behaviour and announcing video-recording of short speech at the end of condition . Non-social stress was typically induced with a loud noise Moritz, Köther, et al., 2015), whilst in two other studies patients were exposed to stressful social and non-social aspects of environment by going outside into a busy urban area (Ellett et al., 2008;Freeman et al., 2015). ...
Introduction:
Stress aggravates delusional symptoms, but the exact underlying mechanisms are still not fully understood. One of the routes may be via exacerbation of information processing distortions frequently observed in psychosis. The aim of the present study was thus to investigate the impact of social and sensory stress on specific cognitive processes along with different dimensions of delusional thinking.
Methods:
Nineteen individuals affected by schizophrenia and 15 healthy controls were assessed under 3 experimental conditions (social stress, neutral, noise stress), with counter-balanced presentation of stress conditions across participants of both groups. Under each condition participants performed parallel versions of experimental tasks and had to report their level of paranoid thinking and subjective distress.
Results:
Irrespective of condition, patients showed significant impairments in metacognitive accuracy compared with controls. When social stress was applied first, mentalising accuracy decreased significantly in the subsequent condition among patients only. Following exposure to either social or sensory stress, patients reported significantly higher conviction in their paranoid ideas in the subsequent condition.
Conclusions:
Only limited evidence was found for the negative impact of stress on cognitive processes in schizophrenia patients. However, this may not be true for those with more severe information processing abnormalities and/or delusions.
... It seems that even passing exposure to harsh urban environments can have measurable negative psychological effects in both clinical and nonclinical groups. The Camberwell walking study [32] explored the acute psychological effects of exposure to a relatively harsh urban environment on people experiencing persecutory delusions. These authors found increased feelings of anxiety, persecution and negative beliefs about others following a brief walk through the local inner city neighbourhood. ...
... Just as, the between subjects design used in [33] meant that the interaction between individual differences and distinct areas could not be explored, other previous in situ studies have used between subjects designs and, furthermore, they have failed to use appropriate comparison tasks. For example, Ellet et al. [32] used a mindfulness control task instead of comparing responses to a more affluent urban neighbourhood. The authors acknowledged that future research was needed to identify features of the environment that may drive changes in psychological processes. ...
... • In accordance with the urbanicity effect and the findings of previous research on the effects of brief exposure to harsh environments [32,33], baseline measures of mental health and wellbeing were expected to predict in situ threat and trust in the neighbourhoods with stronger correlations existing in the more deprived neighbourhood. ...
This study aimed to understand how people respond to different urban neighbourhoods. We explored whether participants’ mental health and wellbeing, judgements of resident wealth, family SES and sentiments reflected in descriptions of place features predicted in situ sense of threat and trust. Forty-six student participants walked in groups through 2 urban neighbourhoods, separated by a park, in the North West of England, noting responses at pre-determined stops. Significant differences existed in participants’ sense of trust and threat between the 2 neighbourhoods along with differences in perceived resident wealth and sentiments expressed. Participants’ levels of persecutory ideas and their sense of residents’ wealth predicted in situ trust in both neighbourhoods while level of personal resilience predicted the extent of threat felt in the more deprived neighbourhood. Demonstrating the value of the method, these findings have implications for the governance of urban neighbourhoods whereby obvious cues signalling a harsh environment need to be minimised to create more positive psychological responses to places.
... studies; N=total participants; 95% CI=95% confidence interval around mean estimate; Q=a standardized metric for heterogeneity of effect sizes around the mean effect size; I 2 =an estimate of the proportion of observed variability that reflects real effect size variability. N=6 studies had outcomes coded for no effect: Ellett et al., 2008;Nosen & Woody, 2013;Ramsey & Jones, 2015;Zabelina, 2011;Zeidan et al., 2010a. *p<.05; **p<.01; ...
... Filled circles are estimates of potentially missing studies from the trim-and-fill analysis, with the filled diamond and vertical line indicating the estimated population effect size after the trim-and-fill procedure. Aggression (Computerized Task) -1 (Heppner et al., 2008) Anger -1 Anger Rumination Scale -1 (Long & Christian, 2015) Attitude Towards Negative Experiences Scale -Negative Attitudes Towards Negative Experiences -1 (Singer & Dobson, 2007) Average Post Event Processing Degree -1 (Shikatani, Antony, Kuo, & Cassin, 2014) Average Post Event Processing Distress -1 BDI-II -1 Body Image Avoidance Questionnaire -1 Brief Core Schema Scale (BCSS) -Negative Other -1 (Ellett, Freeman, & Garety, 2008) Brief Core Schema Scale (BCSS) -Negative Self -1 (Ellett et al., 2008) Brief Fear of Negative Evaluation Scale -1 (Ellett et al., 2008) Brief Mood Inspection Scale -1 (Alberts & Thewissen, 2011) Center for Epidemiologic Studies Depression Scale DES -Anger -1 (Reynolds, Lin, Zhou, & Consedine, 2015) DES -Contempt -1 (Reynolds et al., 2015) DES -Disgust -1 (Reynolds et al., 2015) DES -Fear -1 (Reynolds et al., 2015) DES -Guilt -1 (Reynolds et al., 2015) DES -Sad -1 (Reynolds et al., 2015) DES -Shame -1 (Reynolds et al., 2015) Difficulties in Emotion Regulation Scale -1 (Watford & Stafford, 2015) DERS -Aware -1 (Erisman & Roemer, 2010) DERS -Clarity -1 (Erisman & Roemer, 2010) DERS -State -2 (Erisman & Roemer, 2010;Watford & Stafford, 2015) Distress Tolerance (Paced Auditory Serial Addition Task -Computerized Version) + 1 ######################################################## 1 No data reported; an F statistic of 0.01 was assumed, which coded for no effect in our database.# 2 No data reported; an F statistic of 0.01 was assumed, which coded for no effect in our database.# ...
... Filled circles are estimates of potentially missing studies from the trim-and-fill analysis, with the filled diamond and vertical line indicating the estimated population effect size after the trim-and-fill procedure. Aggression (Computerized Task) -1 (Heppner et al., 2008) Anger -1 Anger Rumination Scale -1 (Long & Christian, 2015) Attitude Towards Negative Experiences Scale -Negative Attitudes Towards Negative Experiences -1 (Singer & Dobson, 2007) Average Post Event Processing Degree -1 (Shikatani, Antony, Kuo, & Cassin, 2014) Average Post Event Processing Distress -1 BDI-II -1 Body Image Avoidance Questionnaire -1 Brief Core Schema Scale (BCSS) -Negative Other -1 (Ellett, Freeman, & Garety, 2008) Brief Core Schema Scale (BCSS) -Negative Self -1 (Ellett et al., 2008) Brief Fear of Negative Evaluation Scale -1 (Ellett et al., 2008) Brief Mood Inspection Scale -1 (Alberts & Thewissen, 2011) Center for Epidemiologic Studies Depression Scale DES -Anger -1 (Reynolds, Lin, Zhou, & Consedine, 2015) DES -Contempt -1 (Reynolds et al., 2015) DES -Disgust -1 (Reynolds et al., 2015) DES -Fear -1 (Reynolds et al., 2015) DES -Guilt -1 (Reynolds et al., 2015) DES -Sad -1 (Reynolds et al., 2015) DES -Shame -1 (Reynolds et al., 2015) Difficulties in Emotion Regulation Scale -1 (Watford & Stafford, 2015) DERS -Aware -1 (Erisman & Roemer, 2010) DERS -Clarity -1 (Erisman & Roemer, 2010) DERS -State -2 (Erisman & Roemer, 2010;Watford & Stafford, 2015) Distress Tolerance (Paced Auditory Serial Addition Task -Computerized Version) + 1 ######################################################## 1 No data reported; an F statistic of 0.01 was assumed, which coded for no effect in our database.# 2 No data reported; an F statistic of 0.01 was assumed, which coded for no effect in our database.# ...
Objective:
Over the last 10 years, there has been a dramatic increase in published randomized controlled trials (RCTs) of brief mindfulness training (from single-session inductions to multisession interventions lasting up to 2 weeks), with some preliminary indications that these training programs may improve mental health outcomes, such as negative affectivity. This meta-analysis aimed to evaluate whether brief mindfulness training reliably reduces negative affectivity.
Method:
PubMed, PsycINFO, and the Mindfulness Research Monthly Newsletter were systematically searched for brief mindfulness intervention RCTs assessing negative affectivity outcomes (e.g., depression, rumination, anxiety, stress). Sixty-five RCTs, including 5,489 participants predominantly without experience in meditation (64.64% female, mean age = 24.62), qualified for the meta-analytic review.
Results:
The meta-analysis revealed a small but significant effect of brief mindfulness training on reducing negative affectivity compared to control programs (g = .21, p < .001). The overall effect size was significantly moderated by participant characteristics: community samples (g = .41, p < .001) produced larger training effects compared to student samples (g = .14, p = .001; Qbetween p = .03). No significant effect size differences were found between clinical and nonclinical samples. However, when accounting for publication bias, the overall effect size of brief mindfulness training programs on negative affectivity was significantly reduced (g = .04).
Conclusions:
Brief mindfulness training programs are increasingly popular approaches for reducing negative affectivity. This meta-analysis indicates that brief mindfulness training modestly reduces negative affectivity. Quantitative analyses indicated the presence of publication bias (i.e., unpublished null effect studies), highlighting the need to continue rigorous evaluation of brief mindfulness interventions. (PsycINFO Database Record
... More recent experimental approaches to test the stressvulnerability and traumagenic models have demonstrated increased levels of PE in clinical samples exposed to a busy shopping street (Ellett et al., 2008;Freeman et al., 2015) and to interpersonal stressors in a virtual reality environment (Valmaggia et al., 2015;. Virtual reality studies also demonstrated that childhood trauma was associated with higher levels of PE in response to interpersonal stressors (Valmaggia et al., 2015;. ...
... We found that people were approximately 25% more likely to experience PE in assessment windows with siren exposure, after adjusting for PE at baseline and several demographic variables. Our findings are consistent with experimental studies (Ellett et al., 2008; and experience sampling studies (Myin-Germeys et al., 2005;, which demonstrated that stress exposure was associated with higher levels of PE in clinical samples. However, the effect of siren exposure on PE was slightly weaker compared with the association found between stress and PE in previous studies (Myin-Germeys et al., 2005;, which may be due to our investigation of subclinical PE in individuals without self-reported mental illness. ...
There is mounting evidence that exposure to psychological stress and trauma increases risk of subsequent psychotic experiences (PE). However, we lack a clear understanding of the relationships between histories of trauma, stressful events in adulthood, and PE. In the present study, our aim was to investigate whether trauma history augments the risk of experiencing PE when exposed to later stressors in adulthood. We sought to address this by examining the relationship between exposure to rocket-warning sirens and PE during the 2014 Israel–Gaza conflict, using experience sampling. Our sample consisted of 97 healthy Israeli civilians who reported their experiences via smartphone twice daily for 30 days. We conducted multilevel models with time and siren exposure as predictors to estimate PE during the conflict. Siren exposure elicited PE, and PE decreased over time as the conflict persisted. People who had experienced previous trauma in adulthood were more likely to have PE when exposed to sirens compared with people who had experienced childhood trauma. Our current findings are broadly consistent with contemporary models of psychosis, which suggest that stress is involved in its aetiology and could have important implications for early detection and intervention in psychosis.
... Although stress reactivity and adapting of beliefs appear to be highly relevant to the emergence of paranoia, the exact mechanism that links these psychological constructs remains unclear. In particular, studies on psychosis demonstrate cognitive biases to increase under stress (Ellett, Freeman, & Garety, 2008;Keefe & Warman, 2011;Lincoln, Lange, Burau, Exner, & Moritz, 2010;Moritz et al., 2011). Moreover, studies on processes related to RL in the general population suggest that stress has a negative impact on the performance in tasks requiring cognitive flexibility (Alexander, Hillier, Smith, Tivarus, & Beversdorf, 2007) and that stress promotes behavioral persistence and habit behavior (Schwabe & Wolf, 2009. ...
... However, although several studies with participants with psychosis and those vulnerable to psychosis found cognitive biases to be sensitive to stress (e.g. Ellett et al., 2008;Lincoln et al., 2010;Moritz et al., 2011;Moritz, Köther, Hartmann, & Lincoln, 2015), the findings from our study align with a second group of studies that did not confirm this effect: For example, in an experience sampling study with patients with psychosis, Lüdtke et al. (2017) found JTC not to be affected by anxiety and therefore, not to act as a mediator for the effect of anxiety on paranoia. Similarly, in a sample of students with varying psychosis vulnerability, Lincoln et al. (2009) found JTC not to be affected when noise stress was induced. ...
Background
Difficulties in the ability to adapt beliefs in the face of new information are associated with psychosis and its central symptom – paranoia. As cognitive processes and psychotic symptoms are both known to be sensitive to stress, the present study investigated the exact associations between stress, adapting of beliefs [reversal learning (RL), bias against disconfirmatory evidence (BADE), and jumping to conclusions (JTC)] and paranoia. We hypothesized that paranoia would increase under stress and that difficulties in adapting of beliefs would mediate or moderate the link between stress and paranoia. Furthermore, we hypothesized that the investigated effects would be strongest in the group of individuals diagnosed with a psychotic disorder.
Methods
We exposed 155 participants (38 diagnosed with a psychotic disorder, 40 individuals with attenuated psychotic symptoms, 39 clinical controls diagnosed with an obsessive-compulsive disorder, and 38 healthy controls) to a control condition and a stress condition, in which we assessed their levels of paranoia and their ability to adapt beliefs. We applied multilevel models to analyze the data.
Results
Paranoia was higher in the stress condition than in the control condition, b = 1.142, s.e. = 0.338, t (150) = 3.381, p < 0.001. RL, BADE, and JTC did not differ between conditions and did not mediate or moderate the association between stress and paranoia (all p s > 0.05).
Conclusions
The results support the assumption that stress triggers paranoia. However, the link between stress and paranoia does not seem to be affected by the ability to adapt beliefs.
... Social context is thus inextricably bound up with psychotic experiences such as paranoid ideation, and research on mechanisms of paranoid ideation should incorporate social context. Research has shown that when exposed to a social environment, people with persecutory delusions report an increase in levels of anxiety and paranoid ideation 29 . Scientific research in real-life social environments is complicated by the fact that social environments are always changing, and each participant will inevitably encounter different people. ...
... Experimental studies of patients with persecutory delusions found that paranoia increased when they entered a busy shopping street and that this effect was partly mediated by anxiety and depression 29,52 . Experience sampling studies showed associations between the occurrence of minor stressors in daily life and intensity of psychotic experiences in patients and, to a lesser extent, their first-degree relatives and the general population 51,53,54 . ...
This book is a PhD thesis which reports on two clinical research studies. The first study researched mechanisms of paranoid ideation, including the ecological validity of virtual reality social environments for eliciting paranoid ideations and behavior, and safety of use concerning cybersickness (chapter 2-4). The second study was a randomized controlled trial examining the effects of virtual reality-based cognitive behavioral therapy for paranoid ideations and social functioning (chapter 5-7).
... Experience sampling studies have found that moments of subjective stress [52][53][54] and physiological arousal [55] predict an increase in paranoia. Similarly, immersion in a stressful social environment, either in virtual reality [54] or a genuine city street [56], increased state paranoia. Additionally, our royalsocietypublishing.org/journal/rsos ...
... Worry has been found to be present at high levels in highly paranoid people [61], and psychological treatment for worry has been shown to reduce paranoia in a targeted randomized controlled trial [62]. Similarly, induction of stress has been shown to increase state paranoia, mediated by anxiety [6,56], in addition to anxiety predicting higher state paranoia in ambiguous virtual environments [63]. Given the strength of prior evidence, we think it unlikely that anxiety and worry play no part in paranoia and suggest two possibilities for why no effect was found in this study. ...
The sensitization model suggests that paranoia is explained by over-sensitivity to social threat. However, this has been difficult to test experimentally. We report two preregistered social interaction studies that tested (i) whether paranoia predicted overall attribution and peak attribution of harmful intent and (ii) whether anxiety, interpersonal sensitivity and worry predicted the attribution of harmful intent. In Study 1, we recruited a large general population sample (N = 987) who serially interacted with other participants in multi-round dictator games and matched to fair, partially fair or unfair partners. Participants rated attributions of harmful intent and self-interest after each interaction. In Study 2 (N = 1011), a new sample of participants completed the same procedure and additionally completed measures of anxiety, worry and interpersonal sensitivity. As predicted, prior paranoid ideation was associated with higher and faster overall harmful intent attributions, whereas attributions of self-interest were unaffected, supporting the sensitization model. Contrary to predictions, neither worry, interpersonal sensitivity nor anxiety was associated with harmful intent attributions. In a third exploratory internal meta-analysis, we combined datasets to examine the effect of paranoia on trial-by-trial attributional changes when playing fair and unfair dictators. Paranoia was associated with a greater reduction in harmful intent attributions when playing a fair but not unfair dictator, suggesting that paranoia may also exaggerate the volatility of beliefs about the harmful intent of others.
... However, while the quest for the identification of risk factors for psychiatric disorders has understandably led researchers to focus on the mechanisms underlying this potential causal link, various elements suggest that other aspects of the interaction between the urban environment and psychiatric patients are highly relevant topics for research as well. Among these, data showing that once psychosis has emerged, patients struggle to adapt to urban milieu, stay away from it or need to develop various strategies to adapt to it [11][12][13][14][15], suggest that city avoidance in early psychosis patients and ways to overcome it might be an important domain to explore as well. ...
... In sum, these urban tactics should be assessed in patients, however, much more work is needed to evaluate how efficient existing psychological and social tactics could be integrated into an urban therapy. 2. Treatment of paranoid ideation Going outside of home into busy streets may trigger paranoid thoughts [12,13]. Data from Freeman et al. suggest this is linked mainly to increased exposure to social defeat [13], and that it is amenable to treatment, a short CBT intervention inducing a significant decrease in the level of distress [60]. ...
Purpose
Urban living is a major risk factor for psychosis. Considering worldwide increasing rates of urbanization, new approaches are needed to enhance patients’ wellbeing in cities. Recent data suggest that once psychosis has emerged, patients struggle to adapt to urban milieu and that they lose access to city centers, which contributes to isolation and reduced social contacts. While it is acknowledged that there are promising initiatives to improve mental health in cities, concrete therapeutic strategies to help patients with psychosis to better handle urban stress are lacking. We believe that we should no longer wait to develop and test new therapeutic approaches.
Method
In this review, we first focus on the role of urban planning, policies, and design, and second on possible novel therapeutic strategies at the individual level. We review how patients with psychosis may experience stress in the urban environment. We then review and describe a set of possible strategies, which could be proposed to patients with the first-episode psychosis.
Results
We propose to group these strategies under the umbrella term of ‘urban remediation’ and discuss how this novel approach could help patients to recover from their first psychotic episode.
Conclusion
The concepts developed in this paper are speculative and a lot of work remains to be done before it can be usefully proposed to patients. However, considering the high prevalence of social withdrawal and its detrimental impact on the recovery process, we strongly believe that researchers should invest this new domain to help patients regain access to city centers.
... Hence, the sensory inundation may be the missing link between city-induced stress and psychotic symptoms (Ellett et al., 2008) calling for development of efficient mitigation strategies. In our study, patients themselves developed strategies to face this issue, wearing for example headphones or avoiding places with too much noise or visual complexity (Söderstöm et al., 2017). ...
... Taking this approach, some researchers have shown that people with paranoia, compared to nonparanoid people, make more negative appraisals of situations and people's intentions in particular environments (50) or social scenarios created using virtual reality (51,52). The use of realistic scenarios may also facilitate the effectiveness of therapeutic interventions for paranoid patients. ...
Introduction
Much research on the treatment of paranoia has involved cognitive-behavioural interventions that address explicit social cognition processes. However, much of human cognition is preverbal or implicit, raising the possibility that such social judgements are implicated in paranoia. One type of implicit social cognition that has been investigated concerning paranoia is implicit self-esteem with some evidence that it may be possible to change implicit self-esteem using techniques based on conditioning theory. Therefore, the primary purpose of this research is to further evaluate the potential of this approach. At the same time, as a secondary purpose, we introduce a novel way of measuring social cognition that, we argue, has utility for investigating the psychological processes involved in paranoia.
Method
We conducted two proof-of-concept studies of a novel brief intervention based on evaluative conditioning, targeting implicit cognition. The first study was conducted with a large non-clinical sample, while the second study included a small series of psychotic patients. As part of our proof-of-concept evaluation of the potential of evaluative conditioning, we attempted to probe for neurophysiological changes following the intervention using magnetoencephalography in an exploratory way in the clinical sample.
Results
Our results revealed that both non-clinical and clinical participants in the experimental group showed a significant change in how they evaluated themselves in the social cognition task, which could be related to the perception of social information in a less threatening way. In addition, clinical participants in the experimental group showed changes in brain activity during the social cognition task, particularly in regions involved in emotional reactivity and mentalization processes.
Discussion
Our results are encouraging, suggesting that implicit cognition is manipulable, that such manipulation affects underlying neurophysiological mechanisms, and that there may be an impact on paranoid symptoms. However, much more work is required to determine whether this approach can produce meaningful clinical change and be delivered in routine clinical settings. Finally, it is important to note that we are not claiming the clinical effectiveness of our intervention, which is in a very early stage of development. Our goal here is to demonstrate clinical possibilities that warrant further investigation
... Many studies have emphasized the higher frequency of mental illness and stress in urban residents than in rural ones (Ellett et al. 2008). Given the importance of this topic in cities, the fields of neuroarchitecture, neurourbanism, and related psychophysiological research have emerged to study the relationship between the urban density, the human brain, architectural forms, and urban landscapes (Pykett et al. 2020b). ...
Stress is considered one of the foremost essential components in expanding city mental disarranges. In comparison, creating cities that are more compatible with stress has been the focus of many governments, organizations, and researchers. Nevertheless, there are fewer empirical studies in this field. Hence, the present study aims to identify stressors in Zone 8, Municipal District 1 of Tehran, Iran. This study is focused on the descriptive-explanatory research. The data are collected using quantitative-qualitative methods and analyzed by factor analysis and multivariate regression. The findings indicate that the factors identified by factor analysis explain 66.8% of the changes in urban stress reported by citizens. Moreover, in the studied area, 19 factors are identified as the causes of urban stress, as follows (in order of importance): social differentiation and social isolation, lack of security, neighborhood quality, access to mental health-improving places, being able to satisfy and deal with emotions, control and prediction of the environment, the presence of open and green spaces, high-rise construction , social deprivation, stressful urban design, residents' social status, resilience, access to centers and services, substance exposure and abuse, spatial diversity, deprivation, socioeconomic station, urban health, and being an ethnic minority. As a result, trying to control them makes it possible to reduce urban stress significantly.
... More specifically, they showed that perceived lower social status (i.e., interacting with taller person in VR) leads to increased paranoid thoughts. In addition, they found that ambiguous social environments could trigger paranoia (Ellett et al., 2008). Although these studies are notable for their acknowledgment of social aspects of paranoia, they still conceptualized paranoia as a symptom assigned to an individual that is exacerbated by static environmental factors. ...
Paranoia, defined as the unfounded belief that others intend to cause harm, negatively affects individuals across the continuum from healthy to pathological. Despite a definition that is explicitly social, paranoia is often studied as an isolated characteristic of the person who is experiencing it. In the current review, we propose that the study of paranoia could be advanced by adopting a perspective focused on its interactional nature. Specifically, we hypothesize that aberrant dynamic interaction and/or misattunement between social partners may be a critical component in the formation and maintenance of paranoia. We also speculate that the relationship between paranoia and social functioning is bidirectional in which poor interpersonal functioning is both a result of and a contributor to paranoia. This approach may identify novel mechanisms and potential treatment targets.
... While SRT and ART offer an evolutionary scenario for the positive responses to nature, they fall short in providing an adaptive explanation for negative psychological responses (Barbiero & Berto, 2021;Kaplan, 1995;Kaplan & Berman, 2010;Kaplan & Kaplan, 1989). Indeed, many studies indicate that a lack of nature can increase negative psychological responses, including increased stress and negative mood, and lower cognitive function (Dong & Geng, 2023;Ellett et al., 2008;Krabbendam et al., 2021;Soga & Gaston, 2016). ...
A growing body of empirical evidence shows that experiences of nature provide people with diverse psychological benefits, including improved cognitive function and mental health. While our understanding of the proximate causes of these positive psychological responses of humans to nature has advanced, the ultimate (evolutionary) drivers behind them remain poorly understood.
In this study, we provide a summary of several widely accepted evolutionary hypotheses originating from Biophilia , reviewing their challenges and limitations. Subsequently, we propose a new evolutionary psychological hypothesis—the greenery hypothesis—that integrates recent findings in evolutionary psychiatry with many experimental results unexplained by existing hypotheses/theories.
Our proposed hypothesis states that humans have adapted to periodic severe drought and re‐watering cycles by developing both negative and positive psychological responses to the absence or presence of greenery within the landscape as cues to optimise their own behavioural activity.
The greenery hypothesis holds the potential to yield several insights into the fundamental understanding of human psychological responses to nature exposure with significant implications for various related fields, including psychiatry, urban planning, and biodiversity conservation and restoration.
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... Epidemiological research has highlighted the prevalence of mental diseases and stress among urbanites, as mentioned in the previous chapters [1]. The study of the connection between the human brain, urban density, urban landscapes, and architectural forms has been categorised into the fields of neuroarchitecture, neurourbanism, and psychophysiological research due to the significance of this subject in cities [2]. ...
This chapter describes the concept of stress relief urban planning first. Then, according to the identified stressful factors, indicators have been identified, and relationships between them are defined using content analysis. Finally, the theoretical framework and conceptual model of this planning are presented.After introducing the general indicators of stress-relief urban planning, due to the very low frequencies of some indicators and the difficulty of drawing a conceptual model due to the great number of indicators, the interrelationships between the indicators were examined using the Maxqda software and analyzing the content of relevant research, and it was tried to identify the most important indicators considering their interrelationships and frequencies.How the dimensions of stress-relief urban planning interact with each other is very important. For this purpose, after examining the relationships between the effective indicators in this section using the (Maxqda) software, the relationships between the dimensions abovementioned were examined.In this chapter, after identifying the relationship between urban mental health and urban stress, the general research indicators are presented in the form of the theoretical framework and the relationships between them are shown. Moreover, according to the relationships presented in the previous sections and the most important and influential general research indicators, the research conceptual model is presented. According to this figure, urban mental health and urban stress mutually influence each other (directly and indirectly). The indicators extracted from theoretical foundations are classified into two groups.KeywordsUrban stressNeurourbanismStress-relief urban planning
... These findings are consistent with previous research, for example, showing that the highest levels of paranoia are more common in men (Freeman et al., 2011) and that general paranoia is associated with urban dwelling (e.g. Ellett, Freeman, & Garety, 2008;van Os, 2004). There are also, however, some inconsistencies, in that general paranoia is typically associated with lower socio-economic status and migrant status (e.g. ...
Background
The term ‘pandemic paranoia’ has been coined to refer to heightened levels of mistrust and suspicion towards other people specifically due to the COVID-19 pandemic. In this study, we examine the international prevalence of pandemic paranoia in the general population and its associated sociodemographic profile.
Methods
A representative international sample of general population adults ( N = 2510) from five sites (USA N = 535, Germany N = 516, UK N = 512, Australia N = 502 and Hong Kong N = 445) were recruited using stratified quota sampling (for age, sex, educational attainment) and completed the Pandemic Paranoia Scale (PPS).
Results
The overall prevalence rate of pandemic paranoia was 19%, and was highest in Australia and lowest in Germany. On the subscales of the PPS, prevalence was 11% for persecutory threat, 29% for paranoid conspiracy and 37% for interpersonal mistrust. Site and general paranoia significantly predicted pandemic paranoia. Sociodemographic variables (lower age, higher population size and income, being male, employed and no migrant status) explained additional variance and significantly improved prediction of pandemic paranoia.
Conclusions
Pandemic paranoia was relatively common in a representative sample of the general population across five international sites. Sociodemographic variables explained a small but significant amount of the variance in pandemic paranoia.
... Consequently, there have been recent calls in the social sciences and in psychiatry in favor of in situ studies, conducted on an individual level (Bromley et al., 2012;Freeman et al., 2015). One of the first studies in that direction is known as the 'Camberwell walk', where researchers looked at symptoms before and after a walk in a busy street for persons with persecutory delusions (Ellett et al., 2008; see also Freeman et al., 2015). In the same line of research, Ecological Momentary Assessment (EMA) using smartphones has been deployed (see van Os et al., 2014van Os et al., & 2017Myin-Germeys et al., 2009). ...
This article examines the entanglement between feelings of stress and discomfort, physiological arousal and urban experiences of persons living with early psychosis. It adopts a biosocial approach, using mixed methods combining ambulatory skin conductance monitoring, mobile interviews and contextual data, collected through GPS and video recordings. The study draws on and strives to cross-fertilize two recent strands of research. The first relates to the use of digital phenotyping in mental health research. The second explores stress and emotional arousal in cities using ambulatory physiological measures. Empirically, the paper is based on fieldwork in Basel, Switzerland, with nine participants recruited within the Basel Early Treatment Service (BEATS), and four controls. We focus on three salient elements in our results: visual perception of moving bodies, spatial transitions and openness and enclosure of the built environment. The analysis shows how these elements elicit physiological responses of arousal and expressed feelings of discomfort. In the concluding section we discuss the methodological implications of these results and suggest the notion of regime of attention as a focus for future biosocial research on urban mental health.
... While paranoia may manifest in an extreme form among patients with schizophrenia and other psychotic disorders (as persecutory delusions), paranoid experiences and appraisals (albeit of a milder magnitude) are common among individuals without a psychiatric diagnosis (Bebbington et al., 2013;Freeman, 2007;Freeman et al., 2005Freeman et al., , 2019. Paranoia is characterised by anticipation of danger and threat, which is often precipitated by anomalous experiences and stress (Ellett et al., 2008;Freeman et al., 2011Freeman et al., , 2002Lincoln et al., 2009;Lopes and Pinto-Gouveia, 2013). There have been clinical reports of new onsets of paranoia and other psychotic symptoms in individuals without a mental health service history following exposure to COVID-19 and SARS Chacko et al., 2020;Chandra et al., 2020;Cheng et al., 2004;Fischer et al., 2020;Haddad et al., 2020;Sheng et al., 2005), with the impact of COVID-19 on paranoia being more marked among younger people and minority groups (Lopes et al., 2020). ...
Background
During the COVID-19 pandemic, an increase in paranoid thinking has been reported internationally. The development of the Pandemic Paranoia Scale (PPS) has provided a reliable assessment of various facets of pandemic paranoia. This study aimed to (i) identify classes of individuals with varying levels of general paranoia and pandemic paranoia, and (ii) examine associations between classification and worry, core beliefs, and pro-health behaviours.
Methods
An international sample of adults (N = 2510) across five sites completed the Revised-Green Paranoid Thoughts Scale and the PPS. Latent class analysis (LCA) was conducted using these two paranoia variables. Classes were compared on trait worry (Penn State Worry Questionnaire), beliefs about self/others (Brief Core Schema Scales), and pro-health behaviour.
Results
Three latent classes emerged: Class 1 with low R-GPTS and PPS scores, Class 2 with a high R-GPTS score and a moderate PPS score, and Class 3 with high R-GPTS and PPS scores. Compared to Class 1, Classes 2–3 were associated with more worry and negative self- and other-beliefs. Class 3 was further characterised by greater positive-self beliefs and less engagement in pro-health behaviours. Engagement in pro-health behaviours was positively correlated with interpersonal mistrust and negatively correlated with paranoid conspiracy and persecutory threat.
Conclusions
Individuals with a general paranoia tendency were more likely to respond to the global health threats in a suspicious and distrusting way. Our findings suggested that worry and negative self/other beliefs may contribute to not just general paranoia but also pandemic paranoia. The preliminary finding of a link between pro-health behaviours and interpersonal mistrust warrants further examination.
... JTC has been discerned in currently deluded patients, as well as in psychotic individuals with remitted symptoms (Menon et al., 2008;Garety et al., 2011;Ross et al., 2015;Dudley et al., 2016;Andreou et al., 2018). JTC bias has also been found to be increased in stressful circumstances (Ellett et al., 2008;Lincoln et al., 2009), and to become irrelevant after negative symptoms were considered . ...
It is suggested that Jumping To Conclusions (JTC) reasoning bias might contribute to the distortion of external reality. However, the association between psychotic manifestations and JTC is obscure, especially if general intelligence is considered as a mediator. The aim of this study is to investigate the relation between severity, early clinical improvement and remission of symptoms in First Episode Psychosis (FEP) with JTC as an explanatory factor. One hundred seventy-one FEP individuals were evaluated with the Positive and Negative Syndrome Scale (PANSS) at baseline and one month after treatment initiation. Clinical improvement was ascribed as symptom change one-month post-baseline measurements. Symptomatic remission was assessed with the Andreasen severity criteria and JTC with the Beads Task, operationalized through Draws To Decision (DTD) (the lower the number of DTD, the higher the JTC bias). Regarding symptoms severity, total psychotic, total positive psychotic, and hallucinations-item PANSS scores showed a negative association with JTC after controlling for IQ. Regarding early clinical improvement, the association with JTC was non-significant. No significant association was detected between one month remission status of FEP and JTC. Our findings indicate that severity of positive symptoms is not associated with hastiness in decision-making, but rather with a heightened conservatism in terms of increased data gathering. Further research is required to replicate the results and clarify the cognitive processes involved.
... Les hallucinations sont la plupart du temps évaluées dans leurs 2 modalités les plus fréquentes, c'est-à-dire auditives et visuelles. A noter que certains auteurs, dont nous 6 , étudient les idées délirantes (Ellett et al., 2008 ;Janssen et al., 2003 ;Saha et al., 2011) et les hallucinations séparément (Johns et al., 2002 ;Vanheusden et al., 2008 (Stefanis et al., 2002 ;Laguerre et al., 2008 ;Mark & Toulopoulou, 2016 ;Ferchiou et al., 2017). Différentes études dimensionnelles transculturelles d'ailleurs ont montré une stabilité des dimensions dans différentes cultures (Fonseca-Pedrero et al., 2014 ;Kwapil et al., 2011). ...
In this PhD thesis, we explored the hypothesis of an etiological psychotic continuum, which makes the assumption that subclinical psychotic phenomena are associated with the same environmental and genetic risk factors as psychotic disorders. Thanks to this hypothesis, we can use subclinical psychosis as a part of an extended psychotic phenotype.
In a first study, we tested the hypothesis of an etiological continuum by reviewing the studies on the association between subclinical psychosis and a well-known environmental risk factor for psychotic disorders: belonging to an ethnic minority and/or the migration. This systematic review and meta-analysis that included data from 28 articles confirmed our hypothesis that ethnicity is associated with subclinical psychosis.
In a second study, we analyzed the positive subclinical psychotic symptoms using data from a large nation-wide survey the Mental Health in the General Population (MHGP). The main objectives were to assess the prevalence of these symptoms in the general population and to analyze their association with migration status. The prevalence of positive subclinical psychotic symptoms was over 25 %. Our results confirmed, once more, the psychotic continuum hypothesis, by showing an association between migration status (in 1st, 2nd, and 3rd generation) and both psychotic symptoms and disorders.
The third article included in this PhD thesis uses latent class analysis (LCA) to define clusters of subjects from the general population (MHGP survey) according to their psychotic symptoms. Our hypothesis was that the classes found would correspond to the 4 categories a priori defined in the previous work, i.e., no psychotic symptoms, hallucinations, delusions, and hallucinations and delusions. The LCA validated this hypothesis.
The subsequent studies were carried out using data collected within the transnational study EU-GEI (European network of national schizophrenia networks studying gene-environment interactions). In a large sample of controls from the general population, we explored the influence of environmental (and genetic) factors known to be associated with schizophrenia with subclinical psychosis.
The first study using EU-GEI data aimed at assessing the transnational invariance of the scale used to measure subclinical psychosis. Using multigroup categorical confirmatory factor analysis, we found that the CAPE (Community Assessment of Psychic Experiences) has good psychometric characteristics and can be reliably used in the total sample of subjects from the 6 different EU-GEI countries.
The aim of the second paper using EU-GEI data was to analyze the relationships between paternal and paternity age and subclinical psychosis in controls. Paternal age was positively associated with the positive dimension, whereas paternity age was not associated with any dimensions. Our results (i) did not support the idea that delayed fatherhood explains the association between age of paternity and psychosis risk, and (ii) provided more arguments for the hypothesis of an etiological continuum.
In a third work on controls and siblings from EU-GEI, we showed that psychosocial stressors (childhood trauma, self-reported discrimination experiences, low social capital, and stressful life experiences) had independent and additive effects on the level of the 3 subclinical psychotic dimensions of CAPE: positive, depressive, and negative (with certain specificities, in particular concerning discrimination, that was only associated with the positive dimension). We also explored potential interactions between the psychosocial stressors but found that none was significant.
Our last study presented in this thesis assessed the influence of these psycho-social stressors and the polygenic risk score for schizophrenia (PRS-SZ) on the subclinical psychotic dimensions, and explored potential gene-environment interactions. The PRS-SZ was associated with the positive dimension, and this in an additive way with the psycho-social stressors (except social capital). We found no significant gene-environment interactions in our sample.
... Chrysikou 2013); new theoretical approaches to establish the best way to integrate extant knowledge about mental illness and design theory (Golembiewski 2010(Golembiewski , 2012; and explorations of psycho-aetiological mechanisms embedded within the physical environment (e.g. Ellett, Freeman, and Garety 2008;Golembiewski 2013Golembiewski , 2016. Most of this research follows significant changes in models of care following the influential philosophy of Foucault (1965) and the highly polemic action-oriented ethnographies of Goffman (1961) and Rosenhan (1973). ...
There is strong evidence that people with psychosis are highly responsive to environmental changes. The institutional tradition has been blamed for chronic psychotic illness in the past, but there has been little evidence to identify the negative influences that it has perpetrated. This study attempts to identify hitherto unknown factors embedded in the physical design of psychiatric environments. A grounded theory method was chosen for this study. The study was undertaken from April 2013 until May 2015 in a mental health facility with 110 male patients with psychosis mostly diagnosed with chronic schizophrenia. Data were collected by covert non-participant observation and unstructured interviews with nine centre staff. The study found that there are standing patterns of behaviour around affordances – that is, around opportunities for action. When these encourage self-expression, better sensory, and bodily engagement and form meaningful experiences, they are positive and recovery-oriented. However, when they involve competition for territory and relative comfort, they are deleterious to mental health. Standing patterns of behaviour are predictable – be they good or bad. An understanding of these patterns will enable better mental health facility design in the future.
... Dlhodobý pocit neustálej hrozby je stresujúci, spája sa s prežívaním tenzie, obáv, úzkosti a strachu. Niektoré štúdie preukázali, že aj navodenie stresu alebo negatívneho afektu môže zvýrazniť JTC (Ellett et al., 2008;Lincoln et al., 2009). Iné štúdie pri použití aktívnej imaginácie v situácii vyvolávajúcej úzkosť nezistili vplyv na JTC (Ho-wai So et al., 2008). ...
... The evidence suggests that for people vulnerable to psychosis, minor stressors trigger negative affect, which in turn increases likelihood of psychotic experience due in part to difficulties identifying, accepting and modifying emotion (Lincoln et al., 2015a;Lincoln et al., 2017). This hypothesis is supported by research demonstrating that stressors increase both negative affect and psychotic symptoms (Ellett et al., 2008;Myin-Germes and van Os, 2007), and that negative affect immediately precedes increases in paranoia (Kramer et al., 2014). Studies of emotion regulation indicate that, compared with healthy controls, people with psychosis are less aware of their emotions or able to understand them (Henry et al., 2010;Lincoln et al., 2015a;O'Driscoll et al., 2014), report higher levels of threat anticipation (Reininghaus et al., 2016), show greater stress sensitivity (Khoury and Lecomte, 2012;Llerena et al., 2012), and are less able to tolerate distress (Nugent et al., 2014). ...
Background: Current psychological interventions for psychosis focus primarily on cognitive and behavioural management of delusions and hallucinations, with modest outcomes. Emotions are not usually targeted directly, despite evidence that people with psychosis have difficulty identifying, accepting and modifying affective states.
Aims: This study assessed the impact of emotion regulation skills practice on affect and paranoia in seven people who met criteria for a diagnosis of schizophrenia or schizoaffective disorder.
Method: The study utilised a single case ABA design and measured emotion regulation skills, affect and paranoia over baseline, intervention and withdrawal of intervention phases. We predicted that eight sessions of skills rehearsal would lead to improved emotion regulation, reduced negative affect, increased positive affect, and reduced paranoia.
Results: Most participants were able to learn to regulate their emotions, and reported reduced negative affect and paranoia. There was no clear pattern of change for positive affect.
Conclusions: These findings suggest that emotion can be targeted in psychosis, and is associated with reduced paranoia. Emotion regulation may constitute a key treatment target in cognitive behavioural therapy for psychosis.</p
... The experimental approach has also been applied to study the effects of specific urban environments. For example, passing through a deprived urban environment increased anxiety and reduced trust in patients with persecutory delusions (Ellett, Freeman, & Garety, 2008), as well as in healthy individuals (Nettle, Pepper, Jobling, & Schroeder, 2014). In patients with persecutory delusions, going out in a busy shopping area had similar effects (Freeman et al., 2014). ...
Twenty-first century urbanization poses increasing challenges for mental health. Epidemiological studies have shown that mental health problems often accumulate in urban areas, compared to rural areas, and suggested possible underlying causes associated with the social and physical urban environments. Emerging work indicates complex urban effects that depend on many individual and contextual factors at the neighbourhood and country level and novel experimental work is starting to dissect potential underlying mechanisms. This review summarizes findings from epidemiology and population-based studies, neuroscience, experimental and experience-based research and illustrates how a combined approach can move the field towards an increased understanding of the urbanicity-mental health nexus.
... Drawing on a vulnerability-stress model (Zubin and Spring 1977) of the aetiology of psychosis, this strand of research aims to more closely analyse ill/ health-environment relations as observed in situ. One of the first experiments in this direction was a walk in Camberwell, London, looking at symptoms before and after a walk in a busy shopping street for persons with persecutory delusions (Ellett et al. 2008; see also : Freeman et al. 2015). This type of experimental procedure is important because it initiates a move out of the laboratory and the clinic, as well as away from epidemiological mapping to consider ordinary situations in cities. ...
Epidemiological research in psychiatry has established robust evidence of the link between urban living and psychosis, but the situated experience of the city, as well as the precise ecology of psychosis remain largely unexplored. In this context, the aim of this paper is to discuss the productive potential of a ‘re-vitalized’ biosocial geographical thinking and researching on urban mental health. We do so through a methodological proposition. First, we discuss the need for a biosocial approach to the city/psychosis nexus and argue that a broader biological view, beyond epigenetics and neurosciences and a more precise investigation of ‘the social’ need to be developed. Second, a telling and recurring motto of recent reflections on biosocial processes is to understand how the environment or the social ‘gets under the skin’. We suggest examining a specific place in this pathway, the skin itself. This leads us to expose a methodology using electrodermal activity (EDA), combined with ethnographic observations and interviews, as a strategy for analysing ecological processes in psychosis. In doing so, we discuss the potential of ‘biosensory ethnographies’ in studies of urban mental health and more broadly as a biosocial approach to the geography of health.
... The emotion that was predictive of subsequent persecutory ideation across both samples was fear. This finding is in line with previous research showing anxiety to be a relevant emotional predecessor of persecutory ideation (e.g., Ellett et al., 2008;Freeman et al., 2015;Lincoln et al., 2010;Veling et al., 2016). However, our results show a moderating effect in the sense that the association between anger and sadness and subsequent persecutory ideation was stronger in the subclinical sample. ...
Etiological models highlight the importance of emotions for the emergence of persecutory ideation. To increase our understanding of their exacerbation, we tested whether this process can be explained by a vicious cycle of negative emotions and persecutory ideation in daily life. Furthermore, we examined whether this process differs in people with and without a psychotic disorder by testing a sample of 34 individuals with elevated psychotic experiences without a diagnosis (subclinical sample) and a sample of 33 individuals diagnosed with schizophrenia spectrum disorder (clinical sample). In both samples, we applied the experience sampling method for 1 week to acquire repeated measures of sadness, fear, anger, shame, and persecutory ideation. Multilevel models showed that all tested negative emotions were associated with persecutory ideation measured at the same time point (p < .05) in both samples. Fear predicted subsequent persecutory ideation (p < .05). There was a moderating effect between sample and anger and sample and sadness predicting subsequent persecutory ideation (p < .05), with these associations being stronger in the subclinical sample. Finally, persecutory ideation predicted subsequent fear, anger, sadness, and shame (p < .05) without a moderating effect of the sample. Hence, the results showed an emotion-unspecific rather than an emotion-specific vicious cycle of negative emotions and persecutory ideation, which possibly contributes to symptom exacerbation and maintenance. Potential differences in mechanisms relating to emotions and persecutory ideation before and after the manifestation of the disorder are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
... Environmental factors have been associated with the development of psychotic symptoms such as paranoia (van Os et al. 2010;Wim Veling et al. 2006). In the Camberwell walk study (Ellett et al. 2008) the effects of exposure to one specific deprived urban environment on thirty individuals with persecutory delusions were studied. The individuals showed increased levels of anxiety, negative beliefs about others and jumping to conclusions. ...
In the early years of virtual reality in mental healthcare several reviews were published (Gregg and Tarrier 2007; G. Riva 2002; 2003; 2005). None of them mentions work done on virtual reality with psychotic disorders yet, though some early work was starting to get published around the same time. There are different psychotic disorders with each their own specified combination of symptom domains, symptom intensity and duration. Wood et al. (2011) suggest a dimensional staging of psychosis, ranging from psychotic-like experiences to severe persistent psychotic episodes. A large body of research is accumulating showing psychotic symptoms can be seen as a transdiagnostic and extended phenotype found in the general population (J. van Os and Reininghaus 2016). When psychotic experiences persist, transition to a psychotic disorder becomes a possibility. The main recognizable symptom domains of psychotic disorders are hallucinations and delusions. Hallucinations are perceptions a person experiences without a corresponding external stimulus. Hallucinations can occur for all five senses. Patients with a psychotic disorder for example often experience auditory hallucinations such as hearing voices. These voices can be commentary, give orders to the patient or call them names. Delusions are beliefs people have about the external reality which are strongly maintained despite strong evidence to the contrary or despite what almost everybody else (of a person’s culture or subculture) believes. The most common delusion found in psychotic disorders is the persecutory delusion (paranoia). People with a persecutory delusion feel others (known or unknown) spy on them, pursue them and threaten their safety (van der Gaag et al. 2012; Beck et al. 2009). Hallucinations and delusions often cause anxiety and make the patient avoid (social) situations, which can be treated with exposure therapy. Other symptom domains of psychotic disorders are negative symptoms and impaired cognition. Patients with negative symptoms experience an diminished emotional expression and avolition. Impaired cognition is about learning deficiencies, whether insufficiently thought or thwarted by deficits. For both negative symptoms and impaired cognition training can help patients learn to master new skills. There are some additional symptom domains in psychotic disorders, but these don’t play a part in virtual reality (yet). See Box 13.1 for an overview.
... the intensity of social interactions, may play a central role in the phenomenon. This second line has recently gained increasing attention in the frame of an emerging trend for experimental in-situ or virtual studies(Bromley, Mikesell, Mates, Smith, & Brekke, 2012;Broome et al., 2013;Ellett, Freeman, & Garety, 2008;Söderström et al., 2016;Valmaggia, Day, & Rus-Calafell, 2016;van Os et al., 2017; T A B L E 1 "Two hit" scenario of interaction between genetic liability and environmental risk factors for development of psychoses ...
Aim:
A growing body of evidence suggests that urban living contributes to the development of psychosis. However, the mechanisms underlying this phenomenon remain unclear. This paper aims to explore the best available knowledge on the matter, identify research gaps and outline future prospects for research strategies.
Method:
A comprehensive literature survey on the main computerized medical research databases, with a time limit up to August 2017 on the issue of urbanicity and psychosis has been conducted.
Results:
The impact of urbanicity may result from a wide range of factors (from urban material features to stressful impact of social life) leading to "urban stress." The latter may link urban upbringing to the development of psychosis through overlapping neuro- and socio-developmental pathways, possibly unified by dopaminergic hyperactivity in mesocorticolimbic system. However, "urban stress" is poorly defined and research based on patients' experience of the urban environment is scarce.
Conclusions:
Despite accumulated data, the majority of studies conducted so far failed to explain how specific factors of urban environment combine in patients' daily life to create protective or disruptive milieus. This undermines the translation of a vast epidemiological knowledge into effective therapeutic and urbanistic developments. New studies on urbanicity should therefore be more interdisciplinary, bridging knowledge from different disciplines (psychiatry, epidemiology, human geography, urbanism, etc.) in order to enrich research methods, ensure the development of effective treatment and preventive strategies as well as create urban environments that will contribute to mental well-being.
... Whereas JTC has appeared to be trait-like in some studies (So et al., 2012), clinical observation indicates that biases and psychotic symptoms often fluctuate over time, even though these fluctuations are hard to predict (Lüdtke, Kriston, Schröder, Lincoln, & Moritz, 2017). Nevertheless, some authors have found associations between the JTC bias and the severity of symptoms (Woodward, Munz, LeClerc, & Lecomte, 2009) and the occurrence of stressors (Ellett, Freeman, & Garety, 2008;Moritz, Köther, Hartmann, & Lincoln, 2015). A more recent research approach has thus begun to elucidate moderator variables that elicit JTC and overconfidence in errors in patients and in individuals at risk for psychosis as well as in individuals with subclinical psychotic symptoms. ...
Background. Jumping to conclusions (JTC) and overconfidence in errors are well established in individuals with a liability to psychosis. Yet, it is unclear whether these biases represent primary versus secondary (epi)phenomena. Experimental research suggests that subjecting individuals to dilemmas and doubt prompts a subsequent hardening of attitudes and may foster delusion-like convictions. For the present study, we examined whether this compensatory conviction process is exaggerated in individuals with a liability to psychosis and might in part explain JTC and overconfidence.
Methods. We adopted a psychometric high-risk approach. A large sample of participants from the general population were screened for psychotic experiences with the Community Assessment of Psychic Experiences scale (CAPE) and then randomly allocated to either a condition in which they should experience doubt or a control condition. Participants (final sample, n = 650) were then tested on JTC and overconfidence with the box task.
Results. Participants who scored high on the positive subscale of the CAPE made fewer draws to decision, showed greater confidence, and made more errors relative to low scorers. Yet, none of the parameters was modulated by experimental condition.
Conclusions. Our results at present do not support the idea that JTC is elevated by a prior experience of a dilemma or doubt. Yet, this possibility should not be entirely dismissed as the presumed process may take time to evolve and perhaps needs to be more pervasive to impact behavior. The quest for variables possibly underlying or moderating cognitive biases in psychosis should continue.
... green space, nature, social and physical disorder) are most important for stress and emotion [3][4][5][6][7] . Some of these features are currently being studied as part of a growing literature that typically reports positive effects of short-term exposure to more natural environments on stress and emotion [61][62][63][64] . However, this strand of research has yet to examine the effects of different neighborhood environments or interactions between nature and neighborhood environments. ...
Living in a disadvantaged neighborhood is associated with worse health and early mortality. Although many mechanisms may partially account for this effect, disadvantaged neighborhood environments are hypothesized to elicit stress and emotional responses that accumulate over time and influence physical and mental health. However, evidence for neighborhood effects on stress and emotion is limited due to methodological challenges. In order to address this question, we developed a virtual reality experimental model of neighborhood disadvantage and affluence and examined the effects of simulated neighborhoods on immediate stress and emotion. Exposure to neighborhood disadvantage resulted in greater negative emotion, less positive emotion, and more compassion, compared to exposure to affluence. However, the effect of virtual neighborhood environments on blood pressure and electrodermal reactivity depended on parental education. Participants from families with lower education exhibited greater reactivity to the disadvantaged neighborhood, while those from families with higher education exhibited greater reactivity to the affluent neighborhood. These results demonstrate that simulated neighborhood environments can elicit immediate stress reactivity and emotion, but the nature of physiological effects depends on sensitization to prior experience.
... They propose that emotional biases (i.e., negative beliefs about the self, worrying and interpersonal sensitivity) and sleep problems along with cognitive biases (inflexibility, jumping to conclusions) lead to paranoia. Support for this model stems from evidence that interventions targeted at these alleged risk factors (e.g., mindfulness, CBT for insomnia) decrease paranoid symptoms (Bullock et al., 2016;Collip et al., 2013;Ellett et al., 2008;Foster et al., 2010;Freeman et al., 2015Freeman et al., , 2016Hepworth et al., 2011;Myers et al., 2011;Visceglia and Lewis, 2011). Yet, some of these studies are compromised by small sample size. ...
To soften the often chronic course of schizophrenia and improve functional outcome, researchers are increasingly interested in prodromal states and psychological risk factors that predict the outbreak of psychotic symptoms, but are also amenable to change. In recent years, depressive symptoms have been proposed as precursors of psychosis and some interventional studies indicate that the amelioration of depressive symptoms and depression-related thinking styles (e.g., worrying) positively affects positive symptoms, thereby “killing two birds with one stone”. Yet, in a prior study, we were unable to find a strong specific predictive role of depression on paranoia over the course of three years, which may have been due to the use of a nonclinical sample with minimal/mild symptom fluctuations. To address this further, in the present study, we adopted a similar methodological approach but assessed a large patient sample with a schizophrenia spectrum disorder at three assessment points; baseline (N = 250), 6 weeks later (n = 207, 82.8% retention) and 6 months after baseline (n = 185, 74% retention). Using cross-lagged modeling, we assessed paranoia with the respective items from the Positive and Negative Syndrome Scale (PANSS) and the Psychosis Rating Scales (PSYRATS) delusions subscale. Depression was measured using the Patient Health Questionnaire-9 (PHQ-9) and the Calgary Depression Scale for Schizophrenia (CDSS). We could identify a significant pathway from depression to paranoia from baseline to post (negative association) but not from post to follow-up. Paranoia significantly predicted depressive symptoms for both intervals. Our findings do not refute claims that depression may precede or even predict psychosis, but such a linkage does not seem to be ubiquitous.
... First, at the level of analysis of the individual, in the vast majority of cases, persons living with a diagnosis of schizophrenia are seen as having the ability to consciously identify, express and reflect on their experiences of urban stress. Following a procedure where stress is 'declared' by participants, levels of stress are recorded before and after (Ellett et al., 2008;Freeman et al., 2015) or during (Reininghaus et al., 2016) Third, what are missing from this body of studies are aspects of 'structural disempowerment' related to governmental investments in mental healthcare or access to affordable housing as factors of precarity. This is what the previously-mentioned studies in geographies of mental health have powerfully provided since the 1980s. ...
The article analyses the specific sense of precarity experienced in cities by persons living with a diagnosis of schizophrenia. It aims to bring a social science perspective on precarity as embodied affect into conversation with perspectives on psychosis in the life sciences. To do so the article focuses on two moments in an interdisciplinary research process involving psychiatrists, linguists and geographers. The first is an epistemic moment describing the co-design of a research laboratory across the social and the life sciences to study participants' precarious encounters with urban situations. The second is an ontological moment discussing the results of co-experimentation across disciplines in the research team. It shows how collaboration within the team led to a redefinition of our respective analytical categories and discusses empirical findings concerning factors of urban stress and protection for persons living with a diagnosis of schizophrenia. The conclusion situates the socio-natural analysis of urban precarity developed in the paper within broader contemporary discussions on the study of bio-social entanglements. Arguing for epistemological plurality and ontological contamination, the paper is both a methodological contribution to contemporary debates in geographies of health and a contribution to studies of urban precarity.
... Las personas con esquizofrenia parecen presentar una percepción emocional alterada (Kring y Elis, 2013), así como niveles más altos de emociones negativas que la población general (Cohen y Minor, 2010). Estos aspectos, además, parecen estar estrechamente relacionados con la manifestación de las alucinaciones y los delirios (Ellett, Freeman y Garety, 2008;Myin-Germeys y Van Os, 2007;Watson et al., 2006). ...
Este capítulo pretende abordar diferentes aspectos que se han visto relevantes en el proceso psicoterapéutico en psicosis desde una visión integradora. El propósito último es ofrecer un marco de análisis que permita a los clínicos acercarse a la formulación clínica de casos desde un modelo transteórico y pragmático, así como analizar algunas formas contrastadas de desarrollar contextos y relaciones terapéuticas que promuevan el cambio. Asimismo, al final del capítulo se plantean algunas consideraciones generales sobre la formación y el papel del terapeuta en el proceso psicoterapéutico en pacientes con psicosis.
... It seems that even brief or remote exposure to physical and social cues indicative of deprivation are associated with negative perceptions about the self and others (Corcoran, Mansfield, Giokas, Hawkins, Bamford, & Marshall, 2017). For example, Ellett, Freeman and Garety (2008) explored the acute effects of exposure to a deprived urban environment on the psychology of people experiencing persecutory delusions. They found that brief exposure to a harsh innercity environment was associated with increased feelings of anxiety and persecution as well as an increase in negative beliefs about others. ...
2 Word count (not including abstract, refs etc.): 9,174 Abstract Different aspects of the neighbourhood social environment have been linked with mental ill-health, however the mechanisms underlying these associations remain poorly understood because of the number and complexity of the components involved. We used a novel statistical approach, network analysis, to explore the complex associations between neighbourhood social cohesion, social disorder and mental health symptoms in a sample of 3,670 adults from an economically deprived region of the UK (mean age [SD] = 49.34 years [18.87]; 57% female). Elasso regularised networks were estimated, and network comparisons were conducted by level of deprivation. Mental health symptoms and neighbourhood components formed relatively distinct clusters of items. These domains were linked primarily by paranoia, although only in the most deprived group. Drunken/rowdy behaviour was particularly influential within the neighbourhood cluster, therefore policies aimed at reducing such disruptive behaviour could have positive knock-on effects for social cohesion and mental health. 4
... First, at the level of analysis of the individual, in the vast majority of cases, persons living with a diagnosis of schizophrenia are seen as having the ability to consciously identify, express and reflect on their experiences of urban stress. Following a procedure where stress is 'declared' by participants, levels of stress are recorded before and after (Ellett et al., 2008;Freeman et al., 2015) or during (Reininghaus et al., 2016) Third, what are missing from this body of studies are aspects of 'structural disempowerment' related to governmental investments in mental healthcare or access to affordable housing as factors of precarity. This is what the previously-mentioned studies in geographies of mental health have powerfully provided since the 1980s. ...
The article analyses the specific sense of precarity experienced in cities by persons living with a diagnosis of schizophrenia. It aims to bring a social science perspective on precarity as embodied affect into conversation with perspectives on psychosis in the life sciences. To do so the article focuses on two moments in an interdiscplinary research process involving psychiatrists, linguists and geographers. The first is an epistemic moment describing the co-design of a research laboratory across the social and the life sciences to study participants' precarious encounters with urban situations. The second is an ontological moment discussing the results of co-experimentation across disciplines in the research team. It shows how collaboration within the team led to a redefinition of our respective analytical categories and discusses empirical findings concerning factors of urban stress and protection for persons living with a diagnosis of schizophrenia. The conclusion situates the socio-natural analysis of urban precarity developed in the paper within broader contemporary discussions on the study of bio-social entanglements. Arguing for epistemological plurality and ontological contamination, the paper is both a methodological contribution to contemporary debates in geographies of health and a contribution to studies of urban precarity.
... Suspicious thinking or paranoia is commonly associated with this pattern, although it is also found with other patterns. Suspicious thinking has also been shown to have roots in insecure attachments, witnessing domestic violence, poverty, institutional care and experiences of bullying, assault and other physical threats (Bentall, Wickham, Shevlin, & Varese, 2012;Ellett, Freeman, & Garety, 2008;Kline et al., 2016;Wickham, Sitko, & Bentall, 2015). ...
Extensive histories of complex developmental trauma and insecure attachment are widespread among people given a diagnosis of personality disorder in forensic settings, and are likely to be important predisposing factors that contribute to their offending behavior. In working with this population, it is important to bear this in mind, and helpful to formulate clients’ challenging behaviors as a set of learned responses to perceived threat, or as survival strategies. Such an approach not only makes the interviewing process more effective, it also helps to avoid perpetuating destructive patterns of behavior and relationship between forensic clients and people in authority. We present seven principles for effective interviewing with this population: (a) careful preparation; (b) a constant focus on the therapeutic relationship; (c) providing structure and containment; (d) adopting a flexible approach; (e) managing therapy-interfering behaviors; (f) obtaining supervision; and (g) adopting a whole-team approach.
... This is implied by Fowler, 2009;Gracie et al., 2007). Specifically related to urban environment, the immediate effect of exposure to a deprived city street increased anxiety and JTC in individuals with delusions (Ellett, Freeman & Garety, 2008). Similarly this type of exposure, led to increases in paranoia, voices, anxiety, negative self and other beliefs and a decrease in positive self-beliefs . ...
Background: Urban environment is a risk factor for psychosis, with literature assessing various conceptualisations of urbanicity, from deprivation to social capital. Cognitive models (Garety et al., 2007), propose the importance of affective and cognitive processes in the development and maintenance of psychosis; however research investigating the potential psychological pathways from urbanicity to psychosis are limited. The current study aims to assess the interplay between urban neighbourhood and psychological processes, on risk of psychosis. Method: This case-control study (134 first episode psychosis cases and 258 population controls), used the social environment assessment tool to elicit participant’s perceptions of their current neighbourhoods safety and social capital. The assessment of psychological variables included, anxiety, schematic beliefs and a jumping to conclusions bias (JTC). The interplay between the variables was assessed using logistic regression and multiple mediation and moderation analyses. Results: Anxiety, schematic beliefs and JTC were associated with increased risk for psychosis; and area safety and social capital was associated with a 1.71 increase in odds for psychosis, although this relationship appeared present for individuals within an intermediate social class. Positive other beliefs partially mediated the association between neighbourhood safety and social capital and psychosis, by reducing risk. Lastly an exploratory three-way interaction indicated the possible importance of a JTC bias in increasing odds for psychosis, in the context of low anxiety, within an environment with low safety and social capital. Conclusion: Similarly to wider literature, the importance of affective and cognitive processes in psychosis is reiterated. This study highlights the complex relationship between psychosis and urban neighbourhood safety and social capital, which is likely to interact with other individual variables in increasing risk. The clinical implications of the protective benefit of positive other beliefs is discussed, in relation to bolstering social support and the field of Community Psychology.
... the intensity of social interactions, may play a central role in the phenomenon. This second line has recently gained increasing attention in the frame of an emerging trend for experimental in-situ or virtual studies(Bromley, Mikesell, Mates, Smith, & Brekke, 2012;Broome et al., 2013;Ellett, Freeman, & Garety, 2008;Söderström et al., 2016;Valmaggia, Day, & Rus-Calafell, 2016;van Os et al., 2017; T A B L E 1 "Two hit" scenario of interaction between genetic liability and environmental risk factors for development of psychoses ...
Review on urbanicity and psychosis
... Ils sont étudiés ensemble ou séparément. Les hallucinations (26,72,85,86) -en raison de la facilité à recueillir les informations en population générale -et les idées délirantes (87,88) Il faut noter que la schizotypie, à la différence des autres psychoses atténuées, ne comprend pas les expériences hallucinatoires. La revue des connaissances sur les caractéristiques cognitives associées aux psychoses atténuées a donné des résultats plus contrastés. ...
Contexte
Les psychoses atténuées désignent des manifestations – symptômes psychotiques, délirants, hallucinatoires ou schizotypie – n’amenant pas de demande de soins en soi. Elles ne sont pas suffisamment nombreuses et/ou sévères pour établir un diagnostic de trouble psychotique, mais se situent dans un continuum avec ceux-ci. Elles sont également associées à certains facteurs de risque de trouble psychotique. Les migrants et les minorités ethniques sont des populations à risque de troubles psychotiques.
L’objectif de ce travail de thèse sera d’analyser les rapports entre le statut migratoire et/ou l’appartenance à une minorité ethnique et différents types de psychoses atténuées. Il permettra d’analyser le continuum psychotique dans ces populations.
Méthodes
Dans un premier temps, nous ferons une revue systématique de littérature des études ayant comparé les psychoses atténuées chez les migrants et/ou membres de minorité ethnique et chez les natifs, en population non clinique. Dans un second temps, nous comparerons les prévalences des symptômes psychotiques chez les migrants et les natifs dans un échantillon national français de 38694 sujets.
Résultats
Nous avons inclus 23 articles dans la revue de littérature, dont 9 sur les symptômes psychotiques, 4 sur les hallucinations, 2 sur les symptômes délirants et 8 sur la schizotypie. Sur les 23 articles, dont la plupart était de type transversale, 14 montraient des différences significatives avec des chiffres plus élevés pour les groupes de migrants et de minorités ethniques, dont 1 non significatif après ajustement statistique ; 2 montraient des différences significatives avec des chiffres moindres pour les groupes de migrants et de minorités ethniques ; 5 ne montraient pas de différence significative et 2 ne faisaient pas d’analyse statistique. Les résultats ne permettaient donc pas de conclure définitive sur la question du statut migratoire ou ethnique comme facteur de risque de psychoses atténuées.
Dans l’étude originale, le statut migratoire était associé à une prévalence significativement plus élevée de symptômes psychotiques, et ce dans la première (après ajustement sur l’âge, le sexe, le niveau d’éducation, le niveau de revenu et le statut marital : OR = 1.53, IC 95 % [1.38-1.68], p < 0.001), la deuxième (OR = 1.38, IC 95 % [1.28-1.48], p < 0.001) et la troisième (OR = 1.46, IC 95 % [1.35-1.57], p < 0.001) générations de migrants.
Conclusion
La revue systématique de la littérature ne permet pas d’affirmer l’existence d’une association statistique claire entre statut migratoire et/ou ethnique et la prévalence des symptômes psychotiques. Cependant, peu d’études ont été réalisées dans le but principal d’analyser les psychoses atténuées chez les migrants et minorités ethniques. L’étude originale reportée ici apporte un argument de poids en faveur d’une prévalence de psychose atténuée augmentée chez les migrants, et ce durant trois générations.
... Similarly, individuals at risk for psychosis show an increased emotional response to stressors in everyday life (Lataster et al., 2009) and an increased endocrine response to daily stress (Collip et al., 2011). Experimental studies have also found both emotional sensitivity and the increase of symptoms in response to stressors in individuals with psychosis (e.g., Ellett et al., 2008;Freeman et al., 2015;Lincoln, Köther et al, 2015;Veling et al., 2016). Hence, there is solid empirical evidence that psychosis and depression are associated with stronger emotional responses to stress, which tends to translate into symptoms. ...
Stress is associated with the development of mental disorders such as depression and psychosis. The ability to regulate emotions is likely to influence how individuals respond to and recover from acute stress, and may thus be relevant to symptom development. To test this, we investigated whether self-reported emotion regulation predicts the endocrine, autonomic, affective, and symptomatic response to and recovery from a stressor. Social-evaluative stress was induced by the Trier Social Stress Test (TSST) in N = 67 healthy individuals (53.7% female, Mage = 29.9). Self-reported habitual emotion regulation skills were assessed at baseline. We measured salivary cortisol, heart rate, negative affect, state depression and state paranoia at three time points: pre-TSST, post-TSST, and after a 10 min recovery phase. Repeated-measures ANOVA showed all indicators to significantly increase in response to the stressor (p < .001) and decrease during the recovery phase (p < .001), except for salivary cortisol, which showed a linear increase (p < .001). The habitual use of maladaptive emotion regulation (e.g., rumination, catastrophizing) significantly predicted an increased affective and reduced cortisol response. Adaptive emotion regulation (e.g., acceptance, reappraisal) was not predictive of the stress response for any of the indicators. Neither type of emotion regulation predicted response during the stress recovery phase. Individuals who habitually resort to maladaptive emotion regulation strategies show a stronger affective and a blunted endocrine stress response, which may make them vulnerable to mental health problems. However, further research is needed to identify the full scope of skills required for effective stress-regulation before this knowledge can be used to develop effective prevention programs.
... Jumping to Conclusion bias (JTC), i.e. a tendency to make hasty decisions without sufficient evidence, has been consistently replicated in the psychosis continuum including studies on healthy individuals with psychotic-like experiences (Bristow et al., 2014;Freeman et al., 2008;McKay et al., 2006;Moritz and Woodward, 2005;Startup et al., 2008;Warman et al., 2007). Jumping to Conclusions bias was suggested to arise in conditions of enhanced distress (Ellett et al., 2008;Warman et al., 2013) and to be related primarily to positive symptoms, delusions in particular. Indeed, a relationship between JTC and delusional ideation was clearly indicated in a recent meta-analysis (McLean et al., 2017). ...
Mental health disorders are one of the biggest threats to human health, especially urban people. Despite the importance of urban mental health, the ways to improve it are unknown. This issue has gained multiple importance in the city of Tehran, which has a serious need to apply these solutions. This research was done with the aim of determining the key strategies to improve the mental health of this city. The research method in this research is descriptive-analytical, and firstly, using content analysis and structural analysis, key solutions are identified, and finally, how to use these solutions is discussed. The findings of the research show that three solutions, drafting and implementing a comprehensive mental health plan, paying attention to beautiful urban design and promoting mental health, and using innovative approaches such as mobile phone health programs and online services as influential variables, are the main and most key solutions. are considered As a result, urban mental health can be significantly improved by applying these solutions.
Paranoia is common in clinical and nonclinical populations, consistent with continuum models of psychosis. A number of experimental studies have been conducted that attempt to induce, manipulate or measure paranoid thinking in both clinical and nonclinical populations, which is important to understand causal mechanisms and advance psychological interventions. Our aim was to conduct a systematic review and meta-analysis of experimental studies (non-sleep, non-drug paradigms) on psychometrically assessed paranoia in clinical and nonclinical populations. The review was conducted using PRISMA guidelines. Six databases (PsycINFO, PubMed, EMBASE, Web of Science, Medline and AMED) were searched for peer-reviewed experimental studies using within and between-subject designs to investigate paranoia in clinical and nonclinical populations. Effect sizes for each study were calculated using Hedge's g and were integrated using a random effect meta-analysis model. Thirty studies were included in the review (total n = 3898), which used 13 experimental paradigms to induce paranoia; 10 studies set out to explicitly induce paranoia, and 20 studies induced a range of other states. Effect sizes for individual studies ranged from 0.03 to 1.55. Meta-analysis found a significant summary effect of 0.51 [95% confidence interval 0.37-0.66, p < 0.001], indicating a medium effect of experimental paradigms on paranoia. Paranoia can be induced and investigated using a wide range of experimental paradigms, which can inform decision-making about which paradigms to use in future studies, and is consistent with cognitive, continuum and evolutionary models of paranoia.
Urban stress is the most important factor in the increase of mental disorders in cities, and its control is the most important solution to increase urban mental health. Identifying the most important indicators that include the main aspects of urban stress is very important in improving the quality of life and developing urban planning that treats stress. For this purpose, this research has been carried out with the aim of explaining the conceptual model of stress-relieving urban planning. The research method in this research is qualitative and to collect data from documentary and library studies and to analyze them, content analysis method was used. The findings of the research indicate that with the reduction of cultural and psychological deprivation, building density, sensory overload, modern architectural style, traffic density (busy roads), stressful urban design, air pollution, immigration, crime, social deprivation , violence, economic deprivation, being an ethnic minority, population density, the amount of time pressure and waste of time and noise pollution and increasing access to resources and services, social support, social capital, spatial diversity, social diversity, social interactions, local integration, green space And access to it, sense of belonging, identity, justice in the city, social cohesion, level of participation, residential stability, vitality, resilience, control and predicting the environment and environmental vision can greatly reduce urban stress and improve urban mental health. gave As a result, the urban planning of the stress therapist, taking into account the mentioned indicators, can be very effective in reducing urban stress and increasing urban mental health.
Background
A single meta-analysis has found that healthy people with higher delusion-proneness tend to gather less information (i.e., make fewer draws to decision, or DTD) on the beads task, although the findings of contributing studies were mixed, and the pooled effect size was small. However, using a new and more reliable “distractor sequences” beads task, we recently found a positive relationship between delusion-proneness and DTD in a healthy sample. In the current study, we re-tested this relationship in a new sample, and tested the possibility that the relationship is driven by participant’s ability to understand and use odds or likelihood information (“odds literacy”).
Methods
Healthy participants (N = 167) completed the distractor sequences beads task, the Peters Delusions Inventory (PDI) which measures delusion-proneness, a measure of odds literacy, and the Depression, Anxiety, and Stress scale.
Results
PDI and DTD were positively correlated, and comparing PDI quartiles on DTD confirmed a statistically significant trend of increasing DTD with PDI quartile. Odds literacy was positively rather than negatively associated with both DTD and PDI. Anxiety was positively correlated with PDI and DTD.
Conclusions
We replicated our earlier finding that DTD and delusion-proneness were positively related in a non-clinical sample, but found that increased odds-literacy did not drive lower PDI and DTD, and hence did not explain their covariance. It is possible however that anxiety and co-occurring risk aversion drive increased delusion-proneness and information-gathering, potentially accounting for the positive relationship between PDI and DTD.
Objectives
To determine whether neighbourhood-level socioenvironmental factors including deprivation and inequality predict variance in psychotic symptoms after controlling for individual-level demographics.
Design
A cross-sectional design was employed.
Setting
Data were originally collected from secondary care services within the UK boroughs of Ealing, Hammersmith and Fulham, Wandsworth, Kingston, Richmond, Merton, Sutton and Hounslow as part of the West London First-Episode Psychosis study.
Participants
Complete case analyses were undertaken on 319 participants who met the following inclusion criteria: aged 16 years or over, resident in the study’s catchment area, experiencing a first psychotic episode, with fewer than 12 weeks’ exposure to antipsychotic medication and sufficient command of English to facilitate assessment.
Outcome measures
Symptom dimension scores, derived from principal component analyses of the Scale for the Assessment of Positive Symptoms and Scale for the Assessment of Negative Symptoms, were regressed on neighbourhood-level predictors, including population density, income deprivation, income inequality, social fragmentation, social cohesion, ethnic density and ethnic fragmentation, using multilevel regression. While age, gender and socioeconomic status were included as individual-level covariates, data on participant ethnicity were not available.
Results
Higher income inequality was associated with lower negative symptom scores (coefficient=−1.66, 95% CI −2.86 to –0.46, p<0.01) and higher levels of ethnic segregation were associated with lower positive symptom scores (coefficient=−2.32, 95% CI −4.17 to –0.48, p=0.01) after adjustment for covariates.
Conclusions
These findings provide further evidence that particular characteristics of the environment may be linked to specific symptom clusters in psychosis. Longitudinal studies are required to begin to tease apart the underlying mechanisms involved as well as the causal direction of such associations.
An experiment is described in which deluded subjects with a diagnosis of schizophrenia or of delusional disorder (paranoia) were compared with a nondeluded psychiatric control group and a normal control group on a probabilistic inference task. Factors relevant to belief formation and maintenance were investigated. Deluded subjects requested less information before reaching a decision and were more ready to change their estimates of the likelihood of an event when confronted with potentially disconfirmatory information. No differences were found between the two diagnostic groups of deluded subjects. The results are discussed in light of prevailing theories of the importance of abnormal experience rather than reasoning biases in the formation and maintenance of delusional beliefs. It is suggested that a reasoning abnormality is involved, which may coexist with perceptual abnormalities.
Scales to measure the severity of different dimensions of auditory hallucinations and delusions are few. Biochemical and psychological treatments target dimensions of symptoms and valid and reliable measures are necessary to measure these.
The inter-rater reliability and validity of the Psychotic Symptom Rating Scales (PSYRATS: auditory hallucination subscale and delusions subscale), which measure several dimensions of auditory hallucinations and delusions were examined in this study.
The two scales were found to have excellent inter-rater reliability. Their validity as compared with the KGV scale (Krawiecka et al. 1977) was explored.
It is concluded that the PSYRATS are useful assessment instruments and can complement existing measures.
In the last 10 years a consensus has developed that the symptoms of psychosis may be better understood by linking the steps between the phenomenological experiences and social, psychological and neurobiological levels of explanation. Cognitive models of psychosis are an important link in this chain. They provide a psychological description of the phenomena from which hypotheses concerning causal processes can be derived and tested; social, individual, and neurobiological factors can then be integrated via their impact on these cognitive processes. In this paper, we set out the cognitive processes that we think lead to the formation and maintenance of the positive symptoms of psychosis and we attempt to integrate into our model research in social factors. If this model proves useful, a fuller integration with the findings of biological research will be required (Frith, 1992).
The paper by Sundquist et al is a welcome addition to a growing body of evidence linking exposures in the urban environment to the onset of schizophrenia (Sundquist et al , 2004, this issue). They also report, in agreement with the literature, that a similar association exists for depression of severity requiring hospital admission, albeit of a much lower effect size than that for schizophrenia and with the caveat that only in a small and biased proportion of cases is the person with clinical depression ever admitted to hospital. The paper represents a truly prospective analysis, and also considers confounding by other important demographic variables and changing exposure status over the period of observation.
The aim of the study was to elucidate the factors contributing to the severity and persistence of delusional conviction. One hundred participants with current delusions, recruited for a treatment trial of psychological therapy (PRP trial), were assessed at baseline on measures of reasoning, emotions, and dimensions of delusional experience. Reasoning biases (belief inflexibility, jumping to conclusions, and extreme responding) were found to be present in one half of the sample. The hypothesis was confirmed that reasoning biases would be related to delusional conviction. There was evidence that belief inflexibility mediated the relationship between jumping to conclusions and delusional conviction. Emotional states were not associated with the reasoning processes investigated. Anxiety, but not depression, made an independent contribution to delusional conviction.
Convention suggests uniformity of incidence of schizophrenia and other psychoses; variation would have implications for their causes and biological characteristics.
To investigate variability in the incidence of psychotic syndromes in terms of place, ethnicity, age, and sex.
Three-center, prospective, comprehensive survey of clinically relevant first-onset psychotic syndromes over a 2-year period (1997-1999). Census data provided the denominator.
Southeast London, Nottingham, and Bristol, England.
One million six hundred thousand person-years yielded 568 subjects aged 16 to 64 years with clinically relevant psychotic syndromes.
The World Health Organization Psychosis Screen and the Schedules for Clinical Assessment in Neuropsychiatry to classify, blind to ethnicity, all DSM-IV psychotic syndromes and the subclasses of schizophrenia, other nonaffective disorders, affective disorders, and substance-induced psychosis.
All syndromes showed a characteristic age distribution. Schizophrenia was significantly more common in men (incidence rate ratio [IRR], 2.3 [95% confidence interval (CI), 1.7-3.1]); affective disorders occurred equally in men and women (IRR, 1.0 [95% CI, 0.7-1.3]). All psychoses were more common in the black and minority ethnic group (crude IRR, 3.6 [95% CI, 3.0-4.2]). Differences in age, sex, and study center accounted for approximately a quarter of this effect (adjusted IRR, 2.9 [95% CI, 2.4-3.5]) in each psychosis outcome. The age-sex standardized incidence rate for all psychoses was higher in Southeast London (IRR, 49.4 [95% CI, 43.6-55.3]) than Nottingham (IRR, 23.9 [95% CI, 20.6-27.2]) or Bristol (IRR, 20.4 [95% CI, 15.1-25.7]). Rates of all outcomes except affective disorders remained significantly higher in Southeast London when the model was expanded to control for ethnicity.
There is significant and independent variation of incidence of schizophrenia and other psychoses in terms of sex, age, ethnicity, and place. This confirms that environmental effects at the individual, and perhaps neighborhood level, may interact together and with genetic factors in the etiology of psychosis.
Traditional instruments that measure self-esteem may not relate directly to the schema construct as outlined in recent cognitive models. The Brief Core Schema Scales (BCSS) aim to provide a theoretically coherent self-report assessment of schemata concerning self and others in psychosis. The scales assess four dimensions of self and other evaluation: negative-self, positive-self, negative-other, positive-other.
We analysed the psychometric properties of the BCSS using a sample of 754 students recruited by email and 252 people with psychosis recruited as part of a trial of cognitive therapy. We report the internal consistency, stability and the factor structure of the scale, and the association of the BCSS with measures of self-esteem and with symptoms of paranoia and grandiosity.
The BCSS have good psychometric properties and have more independence from mood than the Rosenberg Self-Esteem Schedule. People with chronic psychosis reported extreme negative evaluations of both self and others on these scales, but their levels of self-esteem and positive evaluations of self and others were similar to the student sample.
Extreme negative evaluations of self and others appear to be characteristic of the appraisals of people with chronic psychosis, and are associated with symptoms of grandiosity and paranoia in the non-clinical population. The BCSS may provide a more useful measure of schemata about self and others than traditional measures of self-esteem.
Cognitive models of the positive symptoms of psychosis specify the cognitive, social and emotional processes hypothesized to contribute to their occurrence and persistence, and propose that vulnerable individuals make characteristic appraisals that result in specific positive symptoms.
We describe cognitive models of positive psychotic symptoms and use this as the basis of discussing recent relevant empirical investigations and reviews that integrate cognitive approaches into neurobiological frameworks.
Evidence increasingly supports a number of the hypotheses proposed by cognitive models. These are that: psychosis is on a continuum; specific cognitive processes are risk factors for the transition from subclinical experiences to clinical disorder; social adversity and trauma are associated with psychosis and with negative emotional processes; and these emotional processes contribute to the occurrence and persistence of psychotic symptoms. There is also evidence that reasoning biases contribute to the occurrence of delusions.
The benefits of incorporating cognitive processes into neurobiological research include more sophisticated, bidirectional and interactive causal models, the amplification of phenotypes in neurobiological investigations by including emotional processes, and the adoption of more specific clinical phenotypes. For example, there is potential value in studying gene x environment x cognition/emotion interactions. Cognitive models and their derived phenotypes constitute the missing link in the chain between genetic or acquired biological vulnerability, the social environment and the expression of individual positive symptoms.
Although the Fear of Negative Evaluation (FNE) Scale has widespread applicability to many areas of research in personality and social psychology, its utility is sometimes limited by its length. This article presents a brief, 12-item version of the FNE that correlates very highly (f96) with the original scale and that demonstrates psychometric properties that are nearly identical to those of the full-length scale.
Incluye bibliografía e índice
Reviews the 6 approaches to etiology that now preempt the field—ecological, developmental, learning, genetic, internal environment, and neurophysiological models—and proposes a 2nd-order model, vulnerability, as the common denominator. Methods are suggested for finding markers of vulnerability in the hope of revitalizing the field. It is assumed that exogenous and/or endogenous challengers elicit a crisis in all humans, but depending on the intensity of the elicited stress and the threshold for tolerating it (i.e., one's vulnerability), the crisis will either be contained homeostatically or lead to an episode of disorder. Vulnerability and episode stand in a trait–state relation, and markers for each must be provided to distinguish between them. (83 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Urban birth is associated with later schizophrenia. This study examined whether this finding is diagnosis-specific and which individuals are most at risk.
All live births recorded between 1942 and 1978 in any of the 646 Dutch municipalities were followed-up through the National Psychiatric Case Register for first psychiatric admission for psychosis between 1970 and 1992 (N = 42115).
Urban birth was linearly associated with later schizophrenia (incidence rate ratio linear trend (IRR), 1.39; 95% confidence interval (95% CI), 1.36-1.42), affective psychosis (IRR, 1.18; 95% CI, 1.15-1.21) and other psychosis (IRR, 1.27; 95% CI, 1.24-1.30). Individuals born in the highest category of the three-level urban exposure were around twice as likely to develop schizophrenia. Associations were stronger for men and for individuals with early age of onset. The effect of urban birth was also stronger in the more recent birth cohorts.
There are quantitative differences between diagnostic categories in the strength of the association between urban birth and later psychiatric disorder. High rates of psychosis in urban areas may be the result of environmental factors associated with urbanization, the effect of which appears to be increasing over successive generations.
To review critically the evidence for three contemporary theories of delusions.
The theoretical approaches to delusions proposed by Frith and colleagues ('theory of mind' deficits), Garety and colleagues (multi-factorial, but involving probabilistic reasoning biases) and Bentall and colleagues (attributional style and self-discrepancies) are summarised. The findings of empirical papers directly relevant to these proposals are critically reviewed. These papers were identified by computerised literature searches (for the years 1987-1997) and a hand search.
The evidence does not unequivocally support any of the approaches as proposed. However, strong evidence is found to support modifications of Garety and colleagues' and Bentall and colleagues' theories. Studies have replicated a 'jumping to conclusions' data-gathering bias and an externalising attributional bias in people with delusions. There is preliminary evidence for a 'theory of mind' deficit, as proposed by Frith, although possibly related to a more general reasoning bias. Evidence for an underlying discrepancy between ideal and actual self-representations is weaker.
A multi-factorial model of delusion formation and maintenance incorporating a data-gathering bias and attributional style, together with other factors (e.g. perceptual processing, meta-representation) is consistent with the current evidence. It is recommended that these findings be incorporated into cognitive therapy approaches. However, there are limitations to existing research. Future studies should incorporate longitudinal designs and first episode studies, and should not neglect the co-morbidity of delusions, including affective processes, or the multi-dimensional nature of delusions.
Diagnostic criteria for subtypes of delusional beliefs based upon content have rarely been the subject of comment. In this article, several influential accounts of persecutory delusions are reviewed; differences and difficulties are noted, and their potential effect on cognitive psychological investigations discussed. One method of ensuring that researchers study similar phenomena is to use a more detailed definition than currently available, and therefore a new set of criteria is offered. Finally, related methodological problems in this emerging research area are highlighted. The issues discussed may stimulate further research on the content of delusional beliefs.
A multifactorial model of the formation and maintenance of persecutory delusions is presented. Persecutory delusions are conceptualized as threat beliefs. The beliefs are hypothesized to arise from a search for meaning for internal or external experiences that are unusual, anomalous, or emotionally significant for the individual. The persecutory explanations formed reflect an interaction between psychotic processes, pre-existing beliefs and personality (particularly emotion), and the environment. It is proposed that the delusions are maintained by processes that lead to the receipt of confirmatory evidence and processes that prevent the processing of disconfirmatory evidence. Novel features of the model include the (non-defended) direct roles given to emotion in delusion formation, the detailed consideration of both the content and form of delusions, and the hypotheses concerning the associated emotional distress. The clinical and research implications of the model are outlined.
Previous studies of differences in mental health between urban and rural populations are inconsistent.
To examine whether a high level of urbanisation is associated with increased incidence rates of psychosis and depression, after adjustment for age, marital status, education and immigrant status.
Follow-up study of the total Swedish population aged 25-64 years with respect to first hospital admission for psychosis or depression. Level of urbanisation was defined by population density and divided into quintiles.
With increasing levels of urbanisation the incidence rates of psychosis and depression rose. In the full models, those living in the most densely populated areas (quintile 5) had 68-77% more risk of developing psychosis and 12-20% more risk of developing depression than the reference group (quintile 1).
A high level of urbanisation is associated with increased risk of psychosis and depression for both women and men.
The clinical measurements of insight have focused primarily on patients' unawareness of their having a mental disorder and of their need for treatment ([Acta Psychiatr. Scand. 89 (1994) 62; Am. J. Psychiatry 150 (1993) 873]; etc.). A complementary approach focuses on some of the cognitive processes involved in patients' re-evaluation of their anomalous experiences and of their specific misinterpretations: distancing, objectivity, perspective, and self-correction. The Beck Cognitive Insight Scale (BCIS) was developed to evaluate patients' self-reflectiveness and their overconfidence in their interpretations of their experiences. A 15-item self-report questionnaire was subjected to a principle components analysis, yielding a 9-item self-reflectiveness subscale and a 6-item self-certainty subscale. A composite index of the BCIS reflecting cognitive insight was calculated by subtracting the score for the self-certainty scale from that of the self-reflectiveness scale. The scale demonstrated good convergent, discriminant, and construct validity: (a) the BCIS composite index showed a significant correlation with being aware of having a mental disorder on the Scale to Assess Unawareness of Mental Disorder (SUMD; Arch. Gen. Psychiatry 51 (1994) 826) and the self-reflectiveness subscale was significantly correlated with being aware of delusions on the SUMD, (b) the composite index score of the BCIS differentiated inpatients with psychotic diagnoses from inpatients without psychotic diagnoses, and (c) in a separate study, change scores on the BCIS were significantly correlated with change scores on positive and negative symptoms. The results provided tentative support for the validity of the BCIS. Suggestions were made for further investigation of the cognitive processes involved in identifying and correcting erroneous beliefs and misinterpretations.
Recent neurobiological models provide a possible mechanism of daily life stress directly affecting the intensity of psychotic experiences in vulnerable individuals. In order to validate such a mechanism, the impact of daily life stress on psychosis intensity was investigated in two groups at increased risk of onset (relatives) and relapse (patients) of psychosis.
Patients with psychosis in a clinical state of remission (n = 42), first-degree relatives (n = 47), and control subjects (n = 49) were studied with the Experiencing Sampling Method (ESM is a structured diary technique assessing current context and psychopathology in daily life) to assess (1) appraised subjective stress related to daily activities and events, and (2) intensity of subtle psychotic experiences in daily life.
Multilevel regression analyses revealed significant increases in psychosis intensity associated with increases in subjective activity--and event-related stress in patients. First-degree relatives reported increases in psychosis intensity in relation to activity-related stress but not event-related stress. No association was found in control subjects.
Subjects at increased risk for psychosis show continuous variation in the intensity of subtle psychotic experiences associated with minor stresses in the flow of daily life. Behavioural sensitization to environmental stress may therefore be a vulnerability marker for schizophrenia, reflecting dopaminergic hyper-responsivity in response to environmental stimuli.
The urban environment may increase the risk for psychotic disorder in interaction with pre-existing risk for psychosis, but direct confirmation has been lacking. The hypothesis was examined that the outcome of subclinical expression of psychosis during adolescence, as an indicator of psychosis-proneness, would be worse for those growing up in an urban environment, in terms of having a greater probability of psychosis persistence over a 3.5-year period.
A cohort of 918 adolescents from the Early Developmental Stages of Psychopathology Study (EDSP), aged 14-17 years (mean 15.1 years), growing up in contrasting urban and non-urban environments, completed a self-report measure of psychotic symptoms at baseline (Baseline Psychosis) and at first follow-up around 1 year post-baseline (T1). They were again interviewed by trained psychologists for the presence of psychotic symptoms at the second follow-up on average 3.5 years post-baseline (T2).
The rate of T2 psychotic symptoms was 14.2% in those exposed to neither Baseline Psychosis nor Urbanicity, 12.1% in those exposed to Urbanicity alone, 14.9% in those exposed to Baseline Psychosis alone and 29.0% in those exposed to both Baseline Psychosis and Urbanicity. The odds ratio (OR) for the combined exposure was 2.46 [95% confidence interval (CI) 1.46-4.14], significantly greater than that expected if Urbanicity and Baseline Psychosis acted independently.
These findings support the suggestion that the outcome of the developmental expression of psychosis is worse in urban environments. The environment may impact on risk for psychotic disorder by causing an abnormal persistence of a developmentally common expression of psychotic experiences.
ESEARCHERS LIKE TO BE surprised by the data. When new data challenge old beliefs, the field becomes primed for discovery. The aim of this commentary is to let the broader psychiatric community know about recent discoveries in schizophrenia epidemiology, and to speculate on how best to leverage these discoveries to advance knowledge. For those who do not follow the literature closely, recent research in the epidemiology of schizophrenia may come as a surprise. The once cardinal notions that schizophrenia affects men and women equally and is found in all societies with comparable (or equal) incidence are no longer supported by the data. Schizophrenia is not the egalitarian disorder that we once thought it was.1
This paper will review a series of studies using the Experience Sampling Method that suggest that altered sensitivity to stress is an endophenotype for psychosis. The Experience Sampling Method is a structured diary technique allowing the assessment of emotional reactivity to stressors occurring in normal daily life. Elevated emotional reactivity to stress was found in subjects vulnerable to psychosis, suggesting that affective responses to stressors in the flow of daily life are an indicator of genetic and/or environmental liability to psychosis. Indeed, the small stressors in daily life associated with affective responses also predict more intense moment-to-moment variation of subtle positive psychotic experiences. Increased emotional reactivity was found to be independent from cognitive impairments, and argued to constitute evidence of an affective pathway to psychosis that may underlie a more episodic, reactive, good-outcome type of psychosis. Evidence for this hypothesis was found in data suggesting that the experience of stressful life events and early trauma were associated with increased stress-sensitivity, and that women were more likely to display elevated stress-reactivity. These findings are discussed in the light of recent biological and psychological mechanisms.
At least 10-15% of the general population regularly experience paranoid thoughts and persecutory delusions are a frequent symptom of psychosis. Persecutory ideation is a key topic for study. In this article the empirical literature on psychological processes associated with persecutory thinking in clinical and non-clinical populations is comprehensively reviewed. There is a large direct affective contribution to the experience. In particular, anxiety affects the content, distress and persistence of paranoia. In the majority of cases paranoia does not serve a defensive function, but instead builds on interpersonal concerns conscious to the person. However, affect alone is not sufficient to produce paranoid experiences. There is also evidence that anomalous internal experiences may be important in leading to odd thought content and that a jumping to conclusions reasoning bias is present in individuals with persecutory delusions. Theory of mind functioning has received particular research attention recently but the findings do not support a specific association with paranoia. The threat anticipation cognitive model of persecutory delusions is presented, in which persecutory delusions are hypothesised to arise from an interaction of emotional processes, anomalous experiences and reasoning biases. Ten key future research questions are identified, including the need for researchers to consider factors important to the different dimensions of delusional experience.
Experimental research is increasingly important in developing the understanding of paranoid thinking. An assessment measure of persecutory ideation is necessary for such work. We report the reliability and validity of the first state measure of paranoia: The State Social Paranoia Scale. The items in the measure conform to a recent definition in which persecutory thinking has the 2 elements of feared harm and perpetrator intent. The measure was tested with 164 nonclinical participants and 21 individuals at high risk of psychosis with attenuated positive symptoms. The participants experienced a social situation presented in virtual reality and completed the new measure. The State Social Paranoia Scale was found to have excellent internal reliability, adequate test-retest reliability, clear convergent validity as assessed by both independent interviewer ratings and self-report measures, and showed divergent validity with measures of positive and neutral thinking. The measure of paranoia in a recent social situation has good psychometric properties.
Overcoming Paranoid and Suspicious Thoughts
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SPSS Base 12 User's Guide Follow-up study of 4.4 million women and men in Sweden
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Follow-up study of 4.4 million women and men in Sweden
- K Sundquist
- G Frank
- J Sundquist
Sundquist, K., Frank, G., Sundquist, J., 2004. Follow-up study of
4.4 million women and men in Sweden. British Journal of Psychiatry
184, 293–298.
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Reasoning in deluded schizophrenic and paranoid patients: biases in performance on a probabilistic inference task
- Garety
Follow-up study of 4.4 million women and men in Sweden
- Sundquist