Metacognition and persecutory delusions: Tests of a metacognitive model in a clinical population and comparisons with non-patients

Abstract

BACKGROUND. A metacognitive approach to the conceptualization of paranoia as a strategy for managing interpersonal threat has gained some support in studies of non-clinical populations. This study reports a clinical validation of the Beliefs about Paranoia Scale (BaPS), a self-report measure to assess metacognitive beliefs about paranoia. We aimed to replicate the factor structure of a brief version of the measure and test the specific hypotheses that positive beliefs about paranoia would predict levels of suspiciousness, and that negative beliefs about paranoia would predict problematic persecutory delusions. METHOD. A total of 122 patients meeting criteria for a diagnosis of a schizophrenia spectrum disorder completed the questionnaire assessing beliefs about paranoia. In addition, 61 of the participants were administered the Structured Clinical Interview for DSM-IV, and 60 were administered the Positive and Negative Syndromes of Schizophrenia Scale. One hundred and seventy-eight non-patients were also recruited (an undergraduate sample). RESULTS. Principal components factor analysis showed that the three-factor solution was replicated (comprising negative beliefs about paranoia, paranoia as a survival strategy, and normalizing beliefs). This measure showed good internal consistency (alphas ranged from .85 to .91). Correlational analyses revealed that positive beliefs about paranoia were positively associated with levels of suspiciousness, and independent t tests showed that negative beliefs about paranoia were significantly higher in patients with a diagnosis of schizophrenia meeting criteria for persecutory delusions in comparison to those without. Analyses of covariance showed that patients scored higher than non-patients on both positive and negative beliefs, but logistic regression did not demonstrate that co-occurrence of these beliefs predicted patient status. CONCLUSIONS. Three of our four hypotheses were confirmed, suggesting that a metacognitive approach to the conceptualization of paranoia as a strategy for managing interpersonal threat may have some utility for understanding clinical paranoia. Such a model is described and the clinical implications of the findings are also discussed.

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

“…It is clear that anxiety is implicated across both cognitive and affective dimensions of paranoia, which is consistent with predictions of several cognitive models (Garety et al 2001;Morrison, 2001;Freeman et al 2002;Morrison et al 2011). Depression would be expected to be associated with paranoid conviction on the basis of several theories (Bentall et al 2001;Garety et al 2001;Morrison, 2001;Freeman et al 2002), while depressed mood would be expected to be associated with deservedness according to other predictions (Trower & Chadwick, 1995;Melo et al 2009); we found clear support for the former hypothesis and not the latter.…”

“…The specific relationship observed between both positive and negative beliefs about paranoia are consistent with predictions derived from the general S-REF model (Wells & Matthews, 1994), as well as specific metacognitive models of psychosis (Morrison, 2001) and paranoia (Morrison et al 2011). All of the current psychological models of paranoia would predict a relationship between persecutory ideation and negative beliefs about others, which is unsurprising given the definition of paranoia as a persistent mistrust of others and a corresponding tendency to interpret their actions as threatening; this predicted relationship was confirmed within our sample.…”

“…Moreover, the S-REF model predicts that specific metacognitive beliefs will also be associated with paranoia, especially positive (survival) beliefs (Morrison, 2001;Morrison et al 2011).…”

The Beliefs about Paranoia Scale: Confirmatory factor analysis and tests of a metacognitive model of paranoia in a clinical sample

“…The three subscales of the BaPS replicates two previous studies of the 18-item version of the measure Morrison et al, 2011) which suggests reliability of its factor structure. The finding that both survival beliefs and negative beliefs about paranoia were predictive of the severity of suspiciousness, as measured by the PANSS, provides additional support for the metacognitive model of paranoia , and therefore highlights that the severity of paranoia is not just due to the content of paranoid thoughts per se.…”

“…Applying these principles to a metacognitive model of paranoia, Morrison et al (2011) outlined how paranoid thoughts could be engaged with or not, in a similar way to the model of worry in GAD (Wells, 1995). A trigger situation or event (e.g.…”