Psychiatric patients with persistent systematized delusions in the absence of major behavioural abnormalities have been traditionally regarded as largely inaccessible to verbal modes of treatment. This viewpoint is summarized in a standard textbook of psychiatry (Slater & Roth, 1969): ‘… it is a waste of time to argue with a paranoid patient about his delusions…’. Because of such views, and the related emphasis on a pharmacological approach, there is little to guide the clinician in his verbal dealings with patients in whom systematized delusions are the main feature. In contrast to the traditional view, Watts, Powell & Austin (1973) obtained significant changes in the delusional beliefs of three chronic paranoid schizophrenics after less than six hours of verbal intervention. Their procedure was designed to avoid direction confrontation, since they believed that this would induce ‘psychological reactance’ (Brehm, 1966) and might increase, rather than decrease, the strength of the delusions. They were unable to test this hypothesis. The present study aims to examine the effects of two contrasting types of verbal intervention in a larger sample of persistently deluded patients. It was predicted that (i) both interventions will reduce the strength of delusions and (ii) confrontation will produce less change in delusions and any associated behavioural abnormalities than belief modification.

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SynopsisThis study examines the influence of 40 mg of propranolol on agoraphobics throughout 5-hour periods of exposure in vivo on 3 alternate days. Twenty-three patients were studied using a double-blind parallel design and 19 followed up for 3 months. The propranolol group spent significantly less time than the placebo group travelling alone in the month after treatment, and had improved significantly less on a measure of general symptoms at 3 months. The adverse influence of propranolol on treatment outcome appeared mainly due to a waning effect in the last hour of exposure. Attempts to measure coping with panics as an independent variable were largely unsuccessful.