Cited by 356Schizophrenia research and treatmentMental Health and PsychiatryAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

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Persecutory delusions: a cognitive perspective on understanding and treatment.

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Freeman, Daniel·2016·The Lancet Psychiatry

DOI 10.1016/s2215-0366(16)00066-3

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Abstract

A spectrum of severity of paranoia (unfounded thoughts that others are deliberately intending to cause harm) exists within the general population. This is unsurprising: deciding whether to trust or mistrust is a vital aspect of human cognition, but accurate judgment of others' intentions is challenging. The severest form of paranoia is persecutory delusions, when the ideas are held with strong conviction. This paper presents a distillation of a cognitive approach that is being translated into treatment for this major psychiatric problem. Persecutory delusions are viewed as threat beliefs, developed in the context of genetic and environmental risk, and maintained by several psychological processes including excessive worry, low self-confidence, intolerance of anxious affect and other internal anomalous experiences, reasoning biases, and the use of safety-seeking strategies. The clinical implication is that safety has to be relearned, by entering feared situations after reduction of the influence of the maintenance factors. An exciting area of development will be a clinical intervention science of how best to enhance learning of safety to counteract paranoia.

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“For example, within the threat-anticipation model of persecutory beliefs (Freeman, 2016), concerns about appearance may be a feature of negative self-concept, a source of worry or a cause for employing safety-seeking or defence behaviours, each of which contribute to the occurrence of threat…”
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“…model we describe here was developed to guide both psychological understanding and treatment, and underlies the face-to-face Feeling Safe program (Freeman et al., 2016) and the guided online program Feeling Safer (Freeman et al., in revision), both of which have shown strong treatment effects.”
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Authors: Freeman, D.
Affiliations: Warneford Hospital (GB)
Corresponding author: Freeman, Daniel
ORCID: Freeman, Daniel
Venue: The Lancet Psychiatry
Publisher: Elsevier BV
Published: 2016-07
Volume: 3
Issue: 7
Pages: 685-692
ISSN: 2215-0366 (ISSN-L)
DOI: 10.1016/s2215-0366(16)00066-3
OpenAlex: W2460693432
Cited by: 356
References: 87
Citations by year: 2026: 52 · 2025: 44 · 2024: 39 · 2023: 48 · 2022: 37 · 2021: 25 · 2020: 25 · 2019: 36 · 2018: 28 · 2017: 16 · 2016: 6
FWCI: 4.09
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: The Lancet Psychiatry (publishedVersion)
PubMed (publishedVersion)
Funders: National Institute for Health and Care Research (RP-2014-05-003)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords: persecutory delusions, paranoia, threat beliefs, cognitive approach, delusion maintenance, reasoning biases, excessive worry, low self-confidence, safety learning
MeSH terms: Cognition, Delusions, Humans, Randomized Controlled Trials as Topic

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Persecutory delusions: a cognitive perspective on understanding and treatment.

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