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Dissertation zugänglich unter
The Association between Social Rank, Attachment, Self-Compassion and Paranoia
Der Zusammenhang zwischen Sozialem Rang, Bindung, Selbst-Mitgefühl und Paranoia
Ascone Michelis, Leonie
(2017) Journal of Behavior Therapy and Experimental Psychiatry. 56; 97-105, doi:10.1016/j.jbtep.2016.08.002; Clinical Psychology & Psychotherapy. 24(2); 348-358. doi: 10.1002/cpp.2003
Dokument 1.pdf (20.534 KB)
Paranoia , Selbstmitgefühl , Bindung , sozialer Rang
Freie Schlagwörter (Englisch):
paranoia , attachment , social rank , self-compassion
Lincoln, Tania M. (Prof. Dr.)
Tag der mündlichen Prüfung:
Kurzfassung auf Englisch:
In a narrative review, Freeman and Garety (2014) discuss and review research on putative causal factors involved in paranoid symptom formation and maintenance. Targeting these mechanisms could improve the way we treat delusions, which is important given the fact that state-of-the-art Cognitive Behavioral Therapy for psychosis (CBTp) has only small to medium effects on paranoid delusions (Mehl, Werner, & Lincoln, 2015; van der Gaag, Valmaggia, & Smit, 2014). Thus, further elaboration on putative causal variables involved in paranoid symptom formation as well as testing theoretically founded interventions for paranoia seems warranted. The latter notion is corroborated by a recent meta-analysis investigating the effect of CBTp on delusions that suggested interventions focusing on causal mechanisms (causal interventionist approach) bring about larger changes in delusions than first-generation studies (Mehl, Werner, & Lincoln, 2015).
The present dissertation focused on extending our understanding of the emergence and maintenance, as well as on exploring recently emerging avenues of potential treatment of paranoia, from three perspectives: social rank and social competition (Study 1 – experimental approach), insecure adult attachment and emotion regulation (Study 2 – cross-sectional approach), and self-compassion (Study 3 – causal interventionist approach). Social rank, insecure attachment and emotion regulation, as well as self-compassion, constitute potential vulnerability and maintaining factors for paranoia that can be derived from the cognitive model of persecutory delusions (Freeman & Garety, 2014). The planned projects attempted to fill research gaps concerning these variables by taking into account interdisciplinary perspectives.
Study 1 looked at paranoid symptom formation from the perspective of social rank theory using a randomized experimental pre-post design with healthy, female participants (N = 172). Results indicated that although the experimental manipulation had a strong effect on state social rank, there was no significant effect on paranoia. Insecure striving (trend-level effect), (i.e. a striving to maintain or gain social rank in order to avoid being perceived as inferior by others) and fears of rejection (i.e. believing that others will generally reject or exclude an individual that cannot ‘keep up’), (see Gilbert et al., 2007) acted as moderators (small effects) regarding paranoid reactions to the experimental manipulations. In sum, the results suggest that social rank changes per se are not causal to paranoia. However, insecure striving and fears of rejection may be additional cognitive vulnerability factors, predictive of differential paranoid reactions across individuals, in according triggering situations.
Study 2 tested assumptions derived from an attachment theory of emotion regulation in adults, using a cross-sectional design in a patient sample with psychosis (N = 60). The results revealed significant group differences between a healthy control group (N = 40) and the psychosis group, with the means of the latter being significantly higher regarding insecure attachment dimensions (namely attachment anxiety [i.e. being preoccupied with attachment] vs. avoidance [i.e. denying the importance of intimate relationships]) and dysfunctional emotion regulation (ER) patterns (i.e. hyperactivating ER = strategies that aggravate negative emotions, such as catastrophization or rumination; vs. blaming others ER). Moreover, hyperactivating ER significantly mediated between attachment anxiety and paranoia, whereas blaming others did not mediate this association. Conversely, blaming others ER mediated between attachment avoidance and paranoia, whereas hyperactivating ER did not mediate this association. In conclusion, the study suggests that predictions inferred from attachment theories of adult emotion regulation could contribute to a more differentiated view on the potential emergence and maintenance of paranoid symptoms in psychosis.
Study 3 investigated the potential causal role of self-compassion in paranoia by using an experimental design, following the causal interventionist approach. A guided introduction to compassion-focused imagery (CF) vs. a neutral control condition was delivered to a clinical sample with a present diagnosis of a psychotic disorder and a history of paranoid delusions (N = 51). There were no specific effects of the imagery intervention on paranoia. The intervention was also non-effective regarding secondary outcomes (i.e. negative emotions, self-criticism, sympathetic arousal, and self-compassion). However, CF imagery had significant effects on self-reassurance (i.e. being kind, warm and understanding towards oneself; see Gilbert, Clarke, Hempel, Miles, & Irons, 2004), (small effect) and happiness (medium effect). Explorative analyses revealed that a majority (≈ 60%) of the participants appraised the intervention positively, indicating good acceptance. To the best of my knowledge Study 3 was one of the first demonstrations that compassion-focused imagery is feasible and accepted in psychotic patients. This finding is not trivial, as many scholars and clinicians were previously convinced that these kinds of interventions were counter-indicated in psychosis. However, since the effects were restricted to a few secondary outcomes, only an adjunct or supportive role of CF imagery in the treatment of psychosis can be recommended at this point.
Taken together, despite several limitations that will be discussed critically in this dissertation, the present studies may add to a more detailed understanding of paranoid symptoms from different perspectives, defining avenues for further investigation.