Abstract
Paranoia is common across the clinical and non-clinical spectrum. Cognitive behavioural therapy for psychosis currently yields modest results, warranting research into symptom-specific maintenance factors to improve outcomes. There is strong evidence of a relationship between insecure attachment and increased paranoia, but little is known about the mediating mechanisms. Emotion dysregulation is associated with both insecure attachment and paranoia, and a candidate causal mechanism. This study aimed to determine if emotion dysregulation mediates the association between attachment and paranoia. Sixty-two individuals with elevated paranoia were recruited from NHS services and community settings across the South of England. Mediation analyses were conducted on trait attachment, emotion regulation and paranoia variables, which were collected at one time point. As predicted, emotion dysregulation mediated the relationship between attachment avoidance and paranoia, and between attachment anxiety and paranoia. Emotion suppression did not mediate the relationship between attachment avoidance and paranoia, possibly due to power. Attachment avoidance correlated with deactivating emotion regulation strategies (e.g. lack of emotional awareness) and attachment anxiety correlated with hyperactivating emotion regulation strategies (e.g. impulse control difficulties). Both deactivating and hyperactivating strategies correlated with paranoia. Emotion dysregulation is not routinely targeted in cognitive behavioural therapy for psychosis. This study suggests that incorporating emotion regulation strategies in therapy may improve clinical outcomes. Experimental studies are now required to support a causal argument, and pilot intervention studies should investigate if emotion regulation skills development (aligned with attachment style) is effective in reducing non-clinical and clinical paranoia.
Highlights
Paranoia is defined as beliefs of persecution, conspiracy, and threat in the absence of supporting evidence (Freeman, 2007)
Current study The current study aims to test the following hypotheses: H1: Emotion dysregulation [as measured by the Difficulties in Emotion Regulation Scale (DERS); Gratz and Roemer, 2004] will mediate the relationship between attachment anxiety [as measured by the Psychosis Attachment Measure (PAM); Berry et al, 2006], and paranoia [as measured by the Revised Green et al, Paranoid Thoughts Scale (R-GPTS); Freeman et al, 2019]
Our findings suggest that emotion regulation may be a valuable target in Cognitive behavioural therapy (CBT) for psychosis characterised by paranoia
Summary
Paranoia is defined as beliefs of persecution, conspiracy, and threat in the absence of supporting evidence (Freeman, 2007) Paranoia exists in both non-clinical and clinical populations, ranging on a continuum from mild suspiciousness to intense distressing delusions (Freeman et al, 2005; Johns and van Os, 2001). While there is evidence for the effectiveness of CBT, the modest and inconsistent findings suggest we may need to explore additional factors involved in the maintenance of psychosis which are not currently targeted in therapy. Cognitive behavioural therapy for psychosis currently yields modest results, warranting research into symptom-specific maintenance factors to improve outcomes. Experimental studies are required to support a causal argument, and pilot intervention studies should investigate if emotion regulation skills development (aligned with attachment style) is effective in reducing non-clinical and clinical paranoia
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