تاثیر نشخوار فکری بر روی حالت اندیشه پردازی پارانوئید در نمونه غیربالینی

Cognitive-behavioral models of paranoia have emphasized the potential role of perseverative thinking styles, such as rumination or worry, in the development, maintenance and exacerbation of paranoid beliefs. This study aimed to experimentally test the hypothesis that rumination may play a role in the maintenance or exacerbation of state paranoid ideation. Following a paranoia induction, 37 nonclinical participants were randomly assigned to either a rumination task or a distraction control condition. In accord with main hypothesis, rumination was associated with maintained levels of paranoia, whereas distraction was associated with a decrease in levels of paranoia. These findings suggest that perseverative thinking may play a role in the maintenance of paranoid ideas, which may have implications for our understanding of the maintenance of paranoia and persecutory delusions in the clinical population. Furthermore, the study used a novel experimental paradigm for inducing paranoia, which may prove valuable for future research aiming to elicit paranoid thoughts and feelings in vivo.

Delusions are complex, multidimensional phenomena, characterized by strongly held, implausible and unfounded ideas that are preoccupying and distressing, and are not shared by other people (Freeman, 2007). Persecutory or paranoid delusions are a prevalent delusion subtype characterized by the individual’s belief that harm is going to occur as a consequence of someone else’s bad intentions (Freeman & Garety, 2000). There are two main distinguishing features of paranoia: the anticipation of a potential threat (Freeman & Garety, 2006) and the intentionality attributed to the other, which distinguishes paranoia from nonpersecutory anxiety (Freeman, 2007). While usually associated with psychosis (Sartorius, Jablensky, & Korten, 1986), increasingly, there is recognition that such beliefs are common in the nonclinical population (e.g., Freeman et al., 2010 and Freeman et al., 2005). This finding, in accord with a dimensional view of psychopathology (e.g., Strauss, 1969), has led researchers to conceptualize persecutory delusions on a continuum with normal experiences (Freeman, 2007). Persecutory delusions would represent the severe end of the continuum, whereas more transient and occasional thoughts of mistrust and suspicion would represent their more common counterparts (e.g., Ellett, Lopes, & Chadwick, 2003). A major implication of this view is that studies of paranoia in clinical and nonclinical populations can be mutually informative. Cognitive-behavioral models of persecutory delusions have emphasized the potential role of coping strategies, such as worry and rumination, in maintaining paranoid beliefs (e.g., Freeman, Garety, Kuipers, Fowler, & Bebbinton, 2002). There is some correlational evidence that repetitive negative thinking, in the form of catastrophic worry (Startup, Freeman, & Garety, 2007) and rumination (Simpson, MacGreggor, Cavanagh, & Dudley, 2012), may be associated with paranoia. One study revealed worry to predict both new occurrences of paranoia and the persistence of existing paranoid ideation (Freeman et al., 2011). However, to date no study has experimentally investigated the association between rumination and paranoia. As such, the present study aims to explore the impact of rumination on paranoid ideation. Theoretical conceptualizations of rumination vary across different research domains (Smith & Alloy, 2009), and major overlaps have been found between rumination and other forms of perseverative cognition (Watkins, 2008 and Williams and Moulds, 2010). Response-styles theory defines rumination as a cognitive coping strategy, characterized by repetitively thinking about the causes, consequences, and symptoms of one's negative affect (Nolen-Hoeksema, 1991). The stress-reactive model extends this account to include perseveration on negative, event related, inferences (Alloy et al., 2000). People who ruminate seem to do so with the aim of better understanding why a given event upsets them (Watkins & Baracaia, 2001). It is proposed that this dwelling and self-analytic cognitive style might lead to counterproductive outcomes, and can increase distress (Brosschot et al., 2006, Lyubomirsky and Nolen-Hoeksema, 1995 and Nolen-Hoeksema, 1991). Rumination has been found to be associated with the likelihood of depressive onset (Nolen-Hoeksema, Parker, & Larson, 1994) and severity of depressive symptomatology (Nolen-Hoeksema, 2008). Trait rumination is associated with greater increases in negative mood following evaluative processing of a failure experience (Watkins, 2004). Experimentally manipulated rumination has been found to increase depressive mood and overgeneral memories in first major depressive episode adolescents (Park, Goodyer, & Teasdale, 2004), and to lead to more negative and distressing autobiographical intrusive memories in nonclinical samples (Williams & Moulds, 2010). Beyond depression, rumination has also been found to maintain negative mood and intrusive memories after exposure to a traumatic stressor (Ehring, Fuchs, & Kläsener, 2009), lead to higher endorsement of maladaptive self-beliefs (Wong & Moulds, 2009) and to the maintenance (Blagden & Craske, 1996; Wong & Moulds) or exacerbation (McLaughlin, Borkovec, & Sibrava, 2007) of anxious mood following anxiety provocation, and to the maintenance of anger following provocation in lab-based studies (Bushman, 2002, Denson et al., 2012 and Rusting and Nolen-Hoeksema, 1998; see Thomsen, 2006, for a review). In depression, where rumination has been most thoroughly studied, a proposed mechanism underlying effects of rumination is the narrowing of attentional focus toward negative information, leading to the exacerbation of negative mood, which in turn strengthens depressogenic beliefs (e.g., Nolen-Hoeksema, 1987). In contrast, distraction, defined as “actively turning one’s attention away from one’s symptoms and negative self-aspects” (Kuehner, Huffziger, & Liebsch, 2009, p. 219), has been found to have a beneficial effect on primed negative mood both in people with a history of depression (Huffziger & Kuehner, 2009) and in student samples (Kuehner, Huffziger, & Liebsch, 2009), as well as being associated with reductions in anger (Denson et al., 2012), anxiety, and maladaptive unconditional self-beliefs following provocation in lab-based studies (Wong & Moulds, 2009). It has been proposed that rumination may play a similar maladaptive role in the maintenance of paranoia as perseverative appraisal of negative interpersonal experiences and their meaning in relation to the self and other people will enhance feelings of vulnerability (Freeman et al., 2002). This narrowing of attention toward negative experiences may lead to greater consideration/awareness of negative and threat-based information about others and hence intensify the sense of being victimized. This would increase anxiety levels, which, in turn, may reinforce paranoid beliefs. This vicious cycle may be further reinforced by secondary beliefs about the benefits of repetitive, or ruminative, thinking, thus maintaining, or perhaps even exacerbating, a paranoid state. In contrast, more adaptive coping strategies, such as distraction or constructive reappraisal, might be hypothesized to promote disengagement from this cycle, thus attenuating thoughts and feelings associated with paranoia. These hypotheses have not been tested empirically. The aim of the current study was to investigate the impact of rumination on paranoid ideation in a nonclinical sample. Specifically, it was hypothesized that, compared to distraction, rumination would maintain or exacerbate levels of paranoia induced in the laboratory context. In order to test the main hypothesis that, compared to distraction, rumination would maintain or exacerbate levels of paranoia, paranoia was induced in all participants and then measured before and after engaging in a guided cognitive coping strategy (rumination vs. distraction). An interaction effect between time of paranoia measurement and cognitive coping strategy was expected. The influence of trait rumination and trait paranoia on the study variables was also explored.

In conclusion, in this experimental study, levels of paranoia were apparently maintained after engagement in rumination and were dissipated in the context of a distraction control condition. This provides some further support for the cognitive model of paranoia (Freeman et al., 2002) and adds to our understanding of the transdiagnostic role of rumination in paranoia (Ellett et al., 2003). If replicated, these findings may have some clinical implications for the assessment, formulation, and treatment of paranoid ideation. Finally, further studies would need to better identify which exact features of rumination account for the maintenance of levels of paranoia, as well as by which specific mechanisms it operates.