A Comparison of Paranoid Ideation in Clients with Psychosis or Anxiety Disorders During an Interactive Video Task

Background. Previous studies have shown that the use of simulated social environments permits paranoid thinking to be studied. These studies have used a cognitive model of paranoia and suggest that anxiety is an important part of the paranoid experience. Additionally, research addressing the relationship of childhood trauma to psychosis indicates that psychotic symptoms are related to childhood abuse and neglect. The aim of the study was to explore the role of anxiety and childhood trauma in psychotic and anxious participants using a simulated social encounter task. Method. 15 individuals with paranoid delusions (diagnosed with a psychotic disorder), 11 with anxiety disorders and 14 non-clinical controls experienced a simulated social encounter task populated by four filmed characters instructed to behave neutrally (n=40). After the task, the participants completed questionnaires to describe their experience of the situation. 5 questionnaires were used to study paranoid thoughts. The first two were the Details of Threat questionnaire and the VR questionnaire. The other 3 were designed specifically for the study (faces, trust and power questionnaires). Additionally, the Beck Anxiety and Depression Inventories and also a childhood trauma questionnaire were used as indicators of emotional distress. Results. Appraisals from the clinical participants but not from the non-clinical ones were persecutory. The psychological variables from the cognitive model that predicted persecutory ideation were anxiety and neglect. Further, over-sensitivity towards the neutral faces of the characters distinguished again, clinical and non-clinical participants. Conclusions. Paranoid thinking was elicited in clinical participants (anxious and psychotic) by a simulation of a social situation but not in normal controls. Anxiety and two forms of childhood trauma (physical and emotional neglect) were closely associated to persecutory thoughts. The results provide support for the cognitive model of paranoid delusions suggesting that anxiety and neglect underlay paranoid thinking. The study also shows the usefulness of simulations in clinical research