The interaction of affective with psychotic processes: A test of the effects of worrying on working memory, jumping to conclusions, and anomalies of experience in patients with persecutory delusions

Abstract

Worry has traditionally been considered in the study of common emotional disorders such as anxiety and depression, but recent studies indicate that worry may be a causal factor in the occurrence and persistence of persecutory delusions. The effect of worry on processes traditionally associated with psychosis has not been tested. The aim of the study was to examine the short-term effects of a bout of worry on three cognitive processes typically considered markers of psychosis: working memory, jumping to conclusions, and anomalous internal experience. Sixty-seven patients with persecutory delusions in the context of a non-affective psychotic disorder were randomised to a worry induction, a worry reduction, or a neutral control condition. They completed tests of the cognitive processes before and after the randomisation condition. The worry induction procedure led to a significant increase in worry. The induction of worry did not affect working memory or jumping to conclusions, but it did increase a range of mild anomalous experiences including feelings of unreality, perceptual alterations, and temporal disintegration. Worry did not affect the occurrence of hallucinations. The study shows that a period of worry causes a range of subtle odd perceptual disturbances that are known to increase the likelihood of delusions. It demonstrates an interaction between affective and psychotic processes in patients with delusions.

Delusional disorder: The role of personality and emotions on delusional ideation

“…By contrast, the role of emotions in the development of DD is lacking, even though delusions appear to have a strong emotional component [20]; for instance, a vicious circle between cognitive biases and emotional disturbances may be involved in delusional patients [9]. Particularly, worry processing and rumination are associated with DLEs in healthy individuals [21] and increase anomalous experiences in delusional patients [22]. Therefore, in delusion phenomena "emotional processes must be given special consideration, even if their exact role is not well understood yet" [2].…”

A brief CBT intervention for depersonalisation/derealisation in psychosis: study protocol for a feasibility randomised controlled trial

“…Further, a longitudinal study of over 3000 participants in the UK found that childhood anxiety was a significant predictor of adult depersonalisation experiences [22]. Likewise, cognitive models of psychosis [23] emphasise the role of emotional processes, particularly anxiety, in the onset and maintenance cycle of psychotic symptoms [5, 24]. …”

Are experiences of psychosis associated with unhelpful metacognitive coping strategies? A systematic review of the evidence

“…More severe perceptual anomalies, but not mild anomalies, reliably distinguished people with non‐clinical paranoia from people with persecutory delusions. In addition, worry was found to increase feelings of detachment from reality, increase perceptual alterations, and affect temporal disintegration (Freeman, Startup, et al, ). This suggests that increased worry may affect cognitive processing and may result in confusing perceptual experiences associated with paranoia.…”