Abstract
More than 10% of the general population regularly experience paranoid thoughts. Persecutory delusions occur in one third of psychiatric patients in the United Kingdom and are associated with severe clinical and social impairment. Furthermore, individuals with elevated vulnerability to paranoia interpret ambiguous environmental information more negatively than those with low vulnerability, a cognitive phenomenon called interpretation bias. We conducted a systematic review and meta-analysis of the association between interpretation bias and paranoia. Twenty studies were included, and our meta-analysis indicated that a negative interpretation bias was associated with paranoia both in clinical (standardized mean difference, or SMD = 1.01; 95% confidence interval [CI] = [0.51, 1.52], p < .001) and nonclinical populations ( SMD = 1.06; 95% CI = [0.28, 1.85], p = .008). Our results also showed that higher negative interpretation bias was positively correlated with the severity of paranoia, and results were consistent in nonclinical ( r = .32; 95% CI = [.21, .43], p < .001) and clinical samples ( r = .38; 95% CI = [.27, .48], p < .001). These findings might orient prevention strategies and psychological interventions for paranoia.
Highlights
Paranoid ideation, including mistrust, suspiciousness, ideas of reference, and persecution, is continuously distributed in the general population, with actual persecutory delusions being placed at the extreme end of the continuum (Bebbington et al, 2013)
The search resulted in 4,335 PubMed articles, 4,534 Web of Science articles, 4,055 PsycINFO articles, and four articles from other sources, which amounted to a sum of 16,928 results
There was no indication of publication bias in the findings of the metaanalysis, only published articles were included in the study—which may have led to both significant or insignificant results being excluded from the review. This meta-analysis and systematic review suggests that there is a pattern of greater interpretation bias in paranoia
Summary
Paranoid ideation, including mistrust, suspiciousness, ideas of reference, and persecution, is continuously distributed in the general population, with actual persecutory delusions being placed at the extreme end of the continuum (Bebbington et al, 2013). Cognitive biases refer to specific cognitive mechanisms, such as attention, interpretation, and recall, each of which are thought to operate at different (typically sequential and cyclical) stages of information processing (see Blanchette & Richards, 2010). Attentional bias is thought of as the preferential selection, for further processing, of one stimulus from among multiple competing stimuli. A bias occurs when the selected stimulus is consistently of one particular type, such as threat in the case of anxiety or paranoid in the case of paranoia. A paranoid interpretation bias would arise once the possible meanings of the presence of the security camera had been processed and just one selected for further encoding and elaboration (e.g., “it is there to protect me” or “it is there to spy on me”). Techniques designed to reduce negative interpretation biases have shown benefits across a range of psychological disorders ( Jones & Sharpe, 2017)
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