Phenomenological evidence for two types of paranoia.

OBJECTIVE: Two types of paranoia have been identified, namely persecution (or 'Poor Me') paranoia, and punishment (or 'Bad Me') paranoia. This research tests predicted differences in phenomenology--specifically, in person evaluative beliefs, self-esteem, depression, anxiety, and anger. METHOD: Fifty-three people with current paranoid beliefs were classified as Poor Me, Bad Me, or neither (classification was reliable). Key dependent variables were measured. RESULTS: All predictions were supported, except the one relating to anger, where the two groups did not differ. The Bad Me group had lower self-esteem, more negative self-evaluative thinking, lower negative evaluations about others, higher depression and anxiety. Importantly, the differences in self-esteem and self-evaluations were not fully accounted for by differences in depression. CONCLUSION: Data support the presence of two distinct topographies of paranoia. Future research is needed to explore the theory further and examine clinical implications.

A cognitive approach to measuring and modifying delusions.

The present paper summarizes and integrates with the existing literature the results of three studies we have conducted on the measurement and modification of delusions. The findings of two of these studies have been presented previously; the third is briefly reported here. A total of 12 people with delusions took part. Ten participated in two investigations that used between-subject multiple-baseline designs; the remaining two, each of whom held three distinct delusions, took part in a study using an across-beliefs multiple-baseline design. A variety of dimensions of delusional experience were monitored over baseline periods of at least 4 weeks, and two distinct cognitive interventions were used: a structured verbal challenge and a planned empirical test. Our focus in the present article is on intervention and the process of change as people come to question and sometimes reject their delusions. We also address related issues, including problems of measurement (i.e. demand characteristics, independent validation), the connection between depression and delusions and the prediction of treatment response. We conclude with specific recommendations for cognitive therapy for delusions.

Measurement and modification of delusional beliefs.

It has been proposed that delusional thinking may be on a continuum with normal behavior and can be assessed by taking account of factors such as the client's degree of belief conviction or the extent of preoccupation with the belief. In our research a number of measures were used to assess the delusional thinking of people diagnosed as schizophrenic. Two interventions were used: (a) a structured verbal challenge and (b) a reality test in which the belief was subject to an empirical test. We used a multiple-baseline, across-subjects design. Of the 6 clients, 2 completely rejected their beliefs, and 3 others significantly reduced their belief conviction. Maintenance was good, and there was evidence that the intervention had enabled 5 of the 6 clients to effectively regulate their delusional thinking.