Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-18T16:18:08.007Z Has data issue: false hasContentIssue false
  • English
  • Français

The Fear of Others: A Pilot Study of Social Anxiety Processes in Paranoia

Published online by Cambridge University Press:  28 September 2012

Katherine Newman Taylor  and
Luisa Stopa
Katherine Newman Taylor*
Affiliation:
Southern Health NHS Foundation Trust and University of Southampton, UK
Luisa Stopa
Affiliation:
Southern Health NHS Foundation Trust and University of Southampton, UK
*
Reprint requests to Katherine Newman Taylor, University of Southampton, UK. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background and Aims: There is good reason to consider the role of social anxiety processes in paranoia; both the research and clinical literature indicate significant overlap between the two presentations. The aim of this study was to explore cognition and behaviour that are typically associated with social phobia, in people with paranoia, and then to draw out theoretical and clinical implications. Method: We used a cross-sectional between-subjects design to compare participants with persecutory delusions (without social phobia), social phobia, a clinical control group with panic disorder, and a non-clinical control group. Ten to 15 people were recruited to each of four groups, with a final total of 48 participants. Each person completed measures of automatic thoughts, underlying assumptions, core beliefs and behaviour, and took part in a semi-structured interview designed to assess process (self-consciousness and attentional focus) and metacognitive beliefs. Results: Surprisingly, measures of cognition and behaviour yielded no systematic differences between people with persecutory delusions and social phobia. Conclusions: People with persecutory delusions may experience overt and underlying cognition typically associated with social phobia, and behave in similar ways in response to perceived social threat. These initial results indicate: (i) that larger scale research is now warranted in order to draw firm conclusions about social anxiety processes in paranoia; (ii) more specific hypotheses to be tested; and (iii) a clinical model of paranoia, based on the cognitive model of social phobia, which might now usefully be validated.

Keywords

Cognitionbehaviourparanoiasocial anxietymetacognition
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 41 , Issue 1 , January 2013 , pp. 66 - 88
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Amir, N., Foa, E. B. and Coles, M. (1998). Automatic activation and strategic avoidance of threat relevant information in Social Phobia. Journal of Abnormal Psychology, 107, 285–290.Google Scholar
Amir, N., Freshman, M. and Foa, E. (2002). Enhanced Stroop interference for threat in social phobia. Journal of Anxiety Disorders, 16, 1–9.CrossRefGoogle Scholar
Bell, V., Halligan, P. W. and Ellis, H. D. (2006). The Cardiff Anomalous Perceptions Scale (CAPS): a new validated measure of anomalous perceptual experience. Schizophrenia Bulletin, 32, 366–377.Google Scholar
Bentall, R. P., Corcoran, R., Howard, R., Blackwood, N. and Kinderman, P. (2001). Persecutory delusions: a review and theoretical integration. Clinical Psychology Review, 21, 1143–1192.CrossRefGoogle ScholarPubMed
Bentall, R. P., Kaney, S. and Bowen-Jones, K. (1995). Persecutory delusions and recall of threat-related, depression-related, and neutral words. Cognitive Therapy and Research, 19, 445–457.Google Scholar
Bentall, R. P., Kaney, S. and Dewey, M. E. (1991). Paranoia and social reasoning: an attribution theory analysis. British Journal of Clinical Psychology, 30, 13–23.CrossRefGoogle ScholarPubMed
Bentall, R. P., Kinderman, P. and Kaney, S. (1994). The self, attributional processes and abnormal beliefs: towards a model of persecutory delusions. Behaviour Research and Therapy, 32, 331–341.Google Scholar
Bogels, S. M. and Mansell, , , W. (2004). Attention processes in the maintenance and treatment of social phobia: hypervigilance, avoidance and self-focused attention. Clinical Psychology Review, 24, 827–856.CrossRefGoogle ScholarPubMed
Cassano, G., Pini, S., Saettoni, M., Rucci, P. and Dell'Osso, L. (1998). Occurrence and clinical correlates of psychiatric comorbidity in patients with psychotic disorders. Journal of Clinical Psychiatry, 59, 60–68.CrossRefGoogle ScholarPubMed
Chadwick, P. D. J., Trower, P. and Dagnan, D. (1999). Measuring negative person evaluations: the Evaluative Beliefs Scale. Cognitive Therapy and Research, 23, 549–559.CrossRefGoogle Scholar
Clark, D. M. (1988). A cognitive model of panic attacks. In Rachman, S. and Maser, J. (Eds.), Panic: psychological perspectives. Hillsdale, NJ: Erlbaum.Google Scholar
Clark, D. M. (1999). Anxiety disorders: why they persist and how to treat them. Behaviour Research and Therapy, 37, S5–27.CrossRefGoogle Scholar
Clark, D. M. (2001). Social Attitudes Questionnaire, revised. Unpublished manuscript: University of Oxford.Google Scholar
Clark, D. M., Ehlers, A., Hackmann, A., McManus, F., Fennell, M., Grey, N., et al. (2006). Cognitive therapy versus exposure and applied relaxation in social phobia: a randomized control trial. Journal of Consulting and Clinical Psychology, 74, 568–578.Google Scholar
Clark, D. M. and Wells, A. (1995). A cognitive model of social phobia. In Heimberg, R. G., Liebowitz, M. R., Hope, D. A. and Schneier, F. R. (Eds.), Social Phobia: diagnosis, assessment and treatment. New York: Guilford Press.Google Scholar
Combs, D. R. and Penn, D. L. (2004). The role of sub-clinical paranoia on social perception and behavior. Schizophrenia Research, 69, 93–104.Google Scholar
Cossoff, S. J. and Hafner, R. J. (1998). The prevalence of comorbid anxiety in schizophrenia, schizoaffective disorder and bipolar disorder. Australian and New Zealand Journal of Psychiatry, 32, 67–72.Google Scholar
Derogatis, L. R. (1994). SCL-90-R: administration, scoring and procedures manual. Minneapolis: National Computer Systems, Inc.Google Scholar
Fear, C., Sharp, H. and Healy, D. (1996). Cognitive processes in delusional disorders. British Journal of Psychiatry, 168, 61–71.Google Scholar
Fenigstein, A. and Vanable, P. A. (1992). Paranoia and self consciousness. Journal of Personality and Social Psychology, 62, 129–138.CrossRefGoogle ScholarPubMed
First, M. B., Spitzer, R. L., Gibbon, M. and Williams, J. B. W. (2001). Structured Clinical Interview for DSM-IV-TR Axis I Disorders – Patient Edition (SCID –I/P, 2/2001 revision). New York: Biometrics Research Department, New York State Psychiatric Institute.Google Scholar
Fowler, D., Freeman, D., Smith, B., Kuipers, E., Bebbington, P., Bashforth, H., et al. (2006). The Brief Core Schema Scales (BCSS): psychometric properties and associations with paranoia and grandiosity in non-clinical and psychosis samples. Psychological Medicine, 36, 749–759.CrossRefGoogle ScholarPubMed
Freeman, D. (2006). Delusions in the non-clinical population. Current Psychiatry Reports, 8, 191–204.CrossRefGoogle Scholar
Freeman, D. and Garety, P. A. (1999). Worry, worry processes and dimensions of delusions: an exploratory investigation of a role for anxiety processes in the maintenance of delusional distress. Behavioural and Cognitive Psychotherapy, 27, 47–62.Google Scholar
Freeman, D. and Garety, P. A. (2000). Comments of the content of persecutory delusions: does the definition need clarification? British Journal of Clinical Psychology, 39, 407–414.Google Scholar
Freeman, D. and Garety, P. A. (2004). Paranoia: the psychology of persecutory delusions. Hove: Psychology Press.Google Scholar
Freeman, D., Garety, P. A., Bebbington, P. E., Smith, B., Rollinson, R. and Fowler, D. (2005) Psychological investigation of the structure of paranoia in a non-clinical population. British Journal of Psychiatry, 186, 427–435.Google Scholar
Freeman, D., Garety, P. A. and Kuipers, E. (2001). Persecutory delusions: developing the understanding of belief maintenance and emotional distress. Psychological Medicine, 31, 1293–1306.Google Scholar
Freeman, D., Garety, P. A., Kuipers, E., Fowler, D. and Bebbington, P. E. (2002). A cognitive model of persecutory delusions. British Journal of Clinical Psychology, 41, 331–347.Google Scholar
Freeman, D., Gittins, M., Pugh, K., Antley, A., Slater, M. and Dunn, G. (2008). What makes one person paranoid and another person anxious? The differential prediction of social anxiety and persecutory ideation in an experimental situation. Psychological Medicine, 38, 1121–1132.Google Scholar
Frith, C. D. (1992). The Cognitive Neuropsychology of Schizophrenia. Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
Garety, P. A. and Freeman, , , D. (1999). Cognitive approaches to delusions: a critical review of theories and evidence. British Journal of Clinical Psychology, 38, 113–154.Google Scholar
Garety, P. A., Hemsley, D. R. and Wessely, S. (1991). Reasoning in deluded schizophrenic and paranoid patients. Journal of Nervous and Mental Disease, 179, 194–201.CrossRefGoogle ScholarPubMed
Hackmann, A., Clark, D. M. and McManus, F. (2000). Recurrent images and early memories in social phobia. Behaviour Research and Therapy, 38, 601–610.CrossRefGoogle ScholarPubMed
Hackmann, A., Surawy, C. and Clark, D. M. (1998). Seeing yourself through others’ eyes: a study of spontaneously occurring images in social phobia. Behavioural and Cognitive Psychotherapy, 26, 3–12.CrossRefGoogle Scholar
Hofmann, S. G. (2007). Cognitive factors that maintain social anxiety disorder: a comprehensive model and its treatment implications. Cognitive Behaviour Therapy, 36, 193–209.Google Scholar
Johns, L. C., Cannon, M., Singleton, N., Murray, R. M., Farrell, M., Brugha, T., et al. (2004). Prevalence and correlates of self-reported psychotic symptoms in the British population. British Journal of Psychiatry, 185, 298–305.Google Scholar
Johns, L. C. and van Os, J. (2001). The continuity of psychotic experiences in the general population. Clinical Psychology Review, 21, 1125–1141.Google Scholar
MacKinnon, K., Newman-Taylor, K. and Stopa, L. (2010). Persecutory delusions and the self: an investigation of implicit and explicit self-esteem. Journal of Behavior Therapy and Experimental Psychiatry, 42, 54–64.CrossRefGoogle ScholarPubMed
Mattick, R. P. and Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455–470.CrossRefGoogle ScholarPubMed
McKay, R., Langdon, R. and Coltheart, M. (2007). The defensive function of persecutory delusions: an investigation using the Implicit Association Test. Cognitive Neuropsychiatry, 12, 1–24.CrossRefGoogle ScholarPubMed
Michail, M. and Birchwood, M. (2009). Social anxiety disorder in first-episode psychosis: incidence, phenomenology and relationship with paranoia. British Journal of Psychiatry, 195, 234–241.Google Scholar
Moorhead, S., Samarasekera, N. and Turkington, D. (2005). Schemas, psychotic themes and depression: a preliminary investigation. Behavioural and Cognitive Psychotherapy, 33, 115–117.Google Scholar
Moritz, S., Werner, R. and von Collani, G. (2006) The inferiority complex in paranoia readdressed: a study with the Implicit AssociationTest. Cognitive Neuropsychiatry, 11, 402–415.CrossRefGoogle Scholar
Morrison, A. P. (2001). The interpretation of intrusions in psychosis: an integrative cognitive approach to psychotic symptoms. Behavioural and Cognitive Psychotherapy, 29, 257–276.Google Scholar
Morrison, A. P., Beck, A. T., Glentworth, D., Dunn, H., Reid, G. S., Larkin, W., et al. (2002). Imagery and psychotic symptoms: a preliminary investigation. Behaviour Research and Therapy, 40, 1053–1062.CrossRefGoogle ScholarPubMed
Mykletun, A., Stordal, E. and Dahl, A. A. (2001). Hospital Anxiety and Depression Scale: factor structure, item analyses and internal consistency. British Journal of Psychiatry, 179, 540–544.Google Scholar
Newman Taylor, K., Graves, A. and Stopa, L. (2009). Strategic cognition in paranoia: the use of thought control strategies in a non-clinical population. Behavioural and Cognitive Psychotherapy, 37, 25–38.Google Scholar
Norton, P. J. and Hope, D. A. (2001). Kernels of truth or distorted perceptions: self and observer ratings of social anxiety and performance. Behavior Therapy, 32, 765–786.Google Scholar
Olin, S. S. and Mednick, S. A. (1996). Risk factors of psychosis: identifying vulnerable populations premorbidly. Schizophrenia Bulletin, 22, 223–240.Google Scholar
Pishyar, R., Harris, L. M. and Menzies, R. G. (2004). Attentional bias for words and faces in social anxiety. Anxiety, Stress, and Coping, 17, 23–36.Google Scholar
Rapee, R. M. and Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35, 741–756.Google Scholar
Rapee, R. M. and Lim, L. (1992). Discrepancy between self- and observer ratings of performance in social phobics. Journal of Abnormal Psychology, 101, 728–731.Google Scholar
Rector, N. A. (2004). Dysfunctional attitudes and symptom expression in schizophrenia: differential associations with paranoid delusions and negative symptoms. Journal of Cognitive Psychotherapy, 18, 163–173.Google Scholar
Scheier, M. F. and Carver, C. S. (1985). Optimism, coping, and health: assessment and implications of generalized outcome expectancies. Health Psychology, 4, 219–247.Google Scholar
Spector, I. P., Pecknold, J. C. and Libman, E. (2003). Selective attentional bias related to the noticeability aspect of anxiety symptoms in generalized social phobia. Journal of Anxiety Disorders, 17, 517–531.Google Scholar
Stopa, L. (1995). Cognitive Processes in Social Anxiety. Unpublished doctoral dissertation, University of Oxford.Google Scholar
Stopa, L. and Clark, D. M. (1992). Cognitive processes in social phobia. Behaviour Research and Therapy, 31, 255–267.Google Scholar
Stopa, L. and Clark, , , D. M. (2000). Social phobia and the interpretation of social events. Behaviour Research and Therapy, 38, 273–283.Google Scholar
Stopa, L., Denton, R., Wingfield, M. and Newman Taylor, K. (in press). The fear of others: a qualitative analysis of interpersonal threat in social phobia and paranoia. Behavioural and Cognitive Psychotherapy.Google Scholar
Taylor, S. and Wald, J. (2003). Expectations and attributions in social anxiety disorder: diagnostic distinctions and relationship to general anxiety and depression. Cognitive Behaviour Therapy, 32, 166–178.Google Scholar
Teasdale, J. D., Moore, R. G., Hayhurst, H., Pope, M., Williams, S. and Segal, Z. V. (2002). Metacognitive awareness and prevention of relapse in depression: empirical evidence. Journal of Consulting and Clinical Psychology, 70, 275–287.Google Scholar
Trower, P. and Chadwick, P. D. J. (1995). Pathways to defence of the self: a theory of two types of paranoia. Clinical Psychology: Science and Practice, 2, 263–277.Google Scholar
Wells, A. (2000) Emotional Disorders and Metacognition: innovative cognitive therapy. Chichester: Wiley.Google Scholar
Wells, A., Stopa, L. and Clark, D. M. (1993). The Social Cognitions Questionnaire. Unpublished.Google Scholar
Zigmond, A. S. and Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361–370.Google Scholar
Submit a response

Comments

No Comments have been published for this article.