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Cognitive Behavioural Therapy (CBT) can reduce paranoid fear, research finds

by Sarah Graham
Thursday 05 March 2015
246 3165

Issue-specific Cognitive Behavioural Therapy (CBT) can help to reduce feelings of paranoid fear, according to new research published in The Lancet journal of psychiatry.

The study, which was conducted by researchers from the Universities of Oxford, Southampton and Manchester, found that a six-session course of CBT led to "a significant improvement in levels of both worry and paranoia", with researchers describing its benefits as "comparable with what's seen with many anti-psychotic medications."

Writing in The Guardian, researcher Professor Daniel Freeman, along with his brother and writing partner Jason, said: "Almost all of us experience paranoia - an unrealistic or exaggerated belief that other people mean you harm - at some point in our lives. In psychiatry the experiences at the most debilitating end of the paranoid spectrum are termed persecutory delusions... People with severe paranoia are often admitted to psychiatric care, typically with a diagnosis such as schizophrenia, and are treated with anti-psychotic drugs."

Since anti-psychotics don't work for every patient, the research aimed to investigate alternative psychological treatments, by tackling one of the contributing factors in patients' paranoid delusions: a tendency to worry.

"Our study involved 150 patients with persistent paranoid beliefs. Most had experienced problems for many years, were taking anti-psychotic medication, and hadn't previously received help from a clinical psychologist. They were worriers, as pretty much all patients with these delusions are," Daniel and Jason Freeman explained.

"We wanted to see what would happen if we could reduce these people's level of worry (but without attempting to persuade them that their paranoid thoughts were wrong). To find out, we randomly allocated half of the group to a six-session course of cognitive behaviour therapy, plus their usual treatment; the other half carried on as they had been doing."

Over a period of eight weeks, the participants learnt CBT techniques to identify and analyse their own thoughts, and to notice the common triggers of their worries and paranoid fears. "They learned how to restrict their anxieties to brief daily 'worry periods', and tried scheduling enjoyable and absorbing activities for the times of the day when they were most prone to worry. Participants also practised 'letting go' of their worry: understanding that thoughts are not facts and that we can learn to watch them come and go in our minds without becoming distressed," the Freeman brothers said.

The CBT proved popular with patients and, crucially, the study found clear indications that worry can in fact be a cause of paranoia, rather than simply existing alongside it. Two-thirds of the improvement in delusions following CBT was shown to be the result of reduced worry. The next stage in their research, the Freemans went on to explain, is to tackle other contributing factors, including "reasoning biases", like a tendency to jump to conclusions, and sleep problems.

"It's worth noting that we don't know which elements of the CBT were most effective. It may be, for instance, that patients benefited to some extent from time with a skilled therapist. And, although the gains were substantial, participants still experienced high levels of worry and paranoia. That suggests that the intervention is best regarded as part of more effective therapy, rather than the sum total of that therapy," they said.

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Updated 09 March 2015