The role of attachment in paranoia: an examination of the impact of attachment imagery in attenuated paranoia and preliminary investigation in clinical participants

A narrative review of the literature examined the relationship between adult attachment style and paranoia in clinical and non-clinical populations. A total of 18 studies(9290 participants), published between 2006 and 2017 met inclusion criteria. There was evidence found for an association between insecure attachment styles in adulthood and symptoms of paranoia across non-clinical and clinical samples. The direction of this relationship is unclear due to a lack of experimental and longitudinal studies, but is likely to involve multiple complex factors. Other findings indicate that the relationship may be symptom specific and suggest potential differences in attachment style between clinical and healthy populations. Methodological limitations and implications of the findings are discussed, with suggestions made for future research.In two empirical studies, the effect of attachment-based imagery interventions on paranoia symptoms and distress are explored. Study one investigated the feasibility and impact of an online attachment-based imagery task in individuals with high levels of subclinical paranoia, over a seven-day follow-up. The findings reveal that the week-long online imagery intervention was not feasible and a single-administration of the intervention had no effect on symptoms. Study two investigated the impact of secure attachment imagery on two individuals with clinical levels of paranoia using a single-case series design. The results provide the first evidence for the effectiveness of secure attachment imagery in reducing paranoia and distress in a clinical population. Implications of the findings and suggestions for future research are discusse