The particular addition to the literature provided by
this study is in showing that a range of cognitive-affective
processing biases are active in people with current
paranoid thinking, each of which is likely to exacerbate
the problems. Greater anticipation of threatening events
was clearly apparent, including negative interpretations
of ambiguity. These biases will maintain a sense of
current threat, defeat, and vulnerability. These are
the sorts of biases addressed in traditional cognitive
behavioral approaches in the generation of alternative
explanations for events and testing out of paranoid ideas.
There was also evidence of a hyperalertness, toward
internal thoughts, how one was coming across, and the
external environment. This attentional style will mean
greater sensitivity to signs of potential threat and hence
many more false alarms. The patients’ goal in any given
situation is the detection of danger, rather than to focus
on other aspects of activities or the environment. In
short, danger will always be in mind. Shifting attentional
focus is likely to be a crucial target of successful clinical
interventions, linked to the observation that patients feel
much less paranoid when engaged in meaningful activity.
Behavioral tests of the differences between maintaining
an internal focus of attention compared with an external
focus of attention are very useful in cognitive therapy. We
also confirmed the association of negative ideas about
the self with paranoia.34,44 Individuals who feel the least
confident of themselves will see themselves as vulnerable
and hence potential targets of hostility. It is not difficult
to envisage how these processing biases may arise from
the adverse social factors associated with psychosis.16,17,45
Our view is that reducing negative ideas about the
self and encouraging more positive views will lead to
improvements in levels of paranoia.