Why Do People With Delusions Fail to Choose More Realistic Explanations for Their Experiences? An Empirical Investigation.
Abstract
Delusions can be viewed as explanations of experiences,. By definition, the experiences are insufficient to merit the delusional explanations. So why have delusions been accepted rather than more realistic explanations? The authors report a study of alternative explanations in 100 individuals with delusions. Patients were assessed on the following criteria: symptom measures, the evidence for the delusions, the availability of alternative explanations, reasoning, and self-esteem. Three quarters of the patients did not report any alternative explanation for the experiences on which the delusions were based. These patients reported significantly more internal anomalous experiences and had a more hasty reasoning style than patients who did have alternative explanations available. Having doubt in a delusion, without an alternative explanation, was associated with lower self-esteem. Clinicians will need to develop plausible and compelling alternative accounts of experience in interventions rather than merely challenge patients' delusional beliefs.
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If patients do have alternative ideas, these may be unpalatable and limited in explanatory power (e.g., 'mental illness', 'brain damage').
“If they do have alternative ideas, these may be unpalatable and limited in explanatory power (e.g., ‘mental illness’, ‘brain damage’) (Freeman et al., 2004).”
From A counterweight model for understanding and treating persecutory delusions. (2025) · cites this paper as Freeman et al., 2004
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- Authors
- Freeman, D., Garety, P. A., Fowler, D., Kuipers, E., Bebbington, P. E., & Dunn, G.
- Affiliations
- University of London (GB)
- University of East Anglia (GB)
- The Royal Free Hospital (GB)
- University of Manchester (GB)
- ORCID
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2004
- Volume
- 72
- Issue
- 4
- Pages
- 671-680
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- OpenAlex
- W2091606641
- Cited by
- 229
- References
- 13
- Citations by year
- 2026: 20 · 2025: 3 · 2024: 3 · 2023: 5 · 2022: 4 · 2021: 11 · 2020: 14 · 2019: 4 · 2018: 13 · 2017: 10 · 2016: 13 · 2015: 13 · 2014: 12 · 2013: 8 · 2012: 13
- FWCI
- 7.33
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Life Sciences › Neuroscience › Cognitive Neuroscience › Hallucinations in medical conditions
- Keywords
- delusions, alternative explanations, self-esteem, delusional disorder
- MeSH terms
- Adult, Delusions, Female, Humans, Male, Problem Solving, Psychotic Disorders, Surveys and Questionnaires, Recurrence, Self Concept, Cognitive Behavioral Therapy
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