Metacognitive Interpersonal Therapy for Treating Persecutory Delusions in Schizophrenia

Abstract

A persecutory delusion (PD) is a person's false belief that others are focusing their attention on him or her with malevolent intentions, which often results in intense anxiety and significant disruption of daily life. PDs are common in schizophrenia, and many patients with schizophrenia do not respond well to current pharmacological treatments. Therefore, effective psychological treatments are needed. The most well-known intervention for PDs continues to be cognitive-behavioral therapy. It aims to reduce patients' stigma and then help them to question the delusional meaning they attribute to events. The authors hypothesized that it is possible to reinforce the clinical approach to PDs on the basis of two important considerations: delusions have a meaning that is connected to a fundamental experiencing of the self as being ontologically vulnerable, and PDs seem to be correlated

Metacognitive approaches to the treatment of psychosis: a comparison of four approaches

“…To date, the primary evidence supporting MIT-P includes a series of case studies. 82 , 83 , 92 , 93 Taken together, this evidence is preliminary but offers a basis for future research into the feasibility, tolerability, and efficacy of this treatment among symptomatic patients.…”

Recovery-Focused Metacognitive Interpersonal Therapy (MIT) for Adolescents with First-Episode Psychosis

“…The first is that psychotic symptoms have a meaning that is connected to the life of the individual experiencing them. As Salvatore et al (2009Salvatore et al ( , 2018 note, MIT proposes that the onset of FEP-and the recurrence of symptoms later in the disorder-may be correlated with a fundamental experiencing of the self as ontologically vulnerable, often elicited by either real or imagined potentially stressful interpersonal situations. This experience of the self as vulnerable can involve seeing oneself as being unable to cope with possible criticism or aggression from others seen as superior and malevolent.…”

Application of Integrative Metacognitive Psychotherapy for Serious Mental Illness

“…As noted above, clinicians encounter diverse patients facing varied problems related to their individual experiences of serious mental illness. Mirroring these clinical realities, among the cases presented in this issue are patients who have different issues: negative symptoms in early ( 23) and later stages of illness ( 24), chronic emotional dysregulation and suicidality (25), disordered thoughts and active substance abuse (26), persecutory delusions (27), emergence from an identity defined by illness (28), and prolonged effects of childhood sexual abuse (29). Also mirroring clinical practices, the therapists whose work is presented in this issue represent different disciplines (psychiatry, clinical psychology, and advanced practice nursing), have varying amounts of experience, and demonstrate practice tendencies tied to different psychotherapeutic traditions (cognitive-behavioral, humanistic, psychodynamic, existential, psychiatric rehabilitation, and so forth).…”

“…For example, one patient seemed unable to even discern the kinds of internal experience from which the basis for volition might take root (24). Another patient was overwhelmed and frozen in the face of persecutory delusions (27), and another was disabled by a history of profound childhood sexual abuse and lived in a state dominated by disorganized and bizarre persecutory claims (29). Another patient had seemingly no ability to do more than engage in grossly self-destructive behavior (25).…”

“…The patient with active substance use, rather than continuing to passively drift from day to day continuously using, began to be able to make sense of why he had abused drugs and alcohol; developing a rationale for his motives and an understanding of the consequences of his behaviors allowed for the potential to not use substances in the future (26). Persecutory delusions were no longer an unquestionable reality imposed on the patient but something that could be reflected upon (27). In the case described by Hillis and colleagues (29), the patient made sense of profoundly confusing statements and mental states as a meaningful consequence of devastating boundary violations experienced early in life.…”