Elsevier

Behavior Therapy

Volume 54, Issue 1, January 2023, Pages 132-140
Behavior Therapy

Self-Structure in Persecutory Delusions☆,☆☆

https://doi.org/10.1016/j.beth.2022.07.011Get rights and content

Highlights

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    First study examining self-structure in persecutory delusions using the card sort task.

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    First study examining whether mindfulness changes self-structure in any clinical group.

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    Self-structure differed between people with persecutory delusions and healthy controls.

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    There was no association between self-structure and delusion symptom severity.

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    Mindfulness therapy changed self-structure with medium-large effect sizes.

Abstract

There is currently limited research examining self-structure in clinical groups and no current data on the extent to which self-structure is amendable to change following psychological therapy. We address this important gap by examining self-structure in individuals with persecutory delusions using the card sort task, an established paradigm measuring key self-structure indices, including the degree to which self-structure is compartmentalized (characterized by primarily positive or negative attributes, as opposed to a mix of both), and the proportion and importance of negative attributes.

In Study 1, individuals with a schizophrenia spectrum diagnosis with current persecutory delusions (clinical group, n = 27) and a healthy control group (n = 47) were compared on self-structure indices. In Study 2 (n = 27), the clinical group also completed the card sort task before and after randomization to either a 12-week mindfulness-based psychological therapy or treatment-as-usual control.

In Study 1, self-structure differed significantly between the clinical and control groups. The clinical group had a greater proportion of negative attributes, assigned more importance to negative self-aspects, and had more compartmentalized self-structures compared with controls. In Study 2 there were no associations between delusion severity and self-structure. Large effect sizes for reductions in compartmentalization and proportion of negative attributes across self-aspects were found following mindfulness therapy. The findings highlight key differences in self-structure between individuals with persecutory delusions and healthy controls, and suggest that it might be possible to change self-structure following psychological therapy. These data support the central role of the self in theoretical models of paranoid thinking.

Section snippets

Study 1

In study one, in line with research in other clinical groups, we first examine self-structure comparing a clinical group with persecutory delusions and a healthy control group. We hypothesized the clinical group would identify a lower number of self-aspects, would use fewer total number of items to describe their self-aspects, would have a greater proportion of negative attributes, and greater compartmentalization of self-structure compared with controls.

design

A between-groups design was used to compare clinical and healthy control groups on five self-structure indices: (a) number of self-aspects identified, (b) total number of items used to describe self-aspects, (c) phi (measure of compartmentalization of self-structure), (d) differential importance (rating of importance of negative self-aspects), and (e) proportion of negative attributes across the self-aspects.

participants

An a priori power analysis indicated at least 21 participants per group were needed to

sample characteristics

The clinical group were significantly older (M = 41.6, SD = 1.55) than the healthy control group (M = 19.0, SD = 1.29), t(70) = 18.75, p < .0005, and there was a greater proportion of males in the clinical group (n = 20) than in the healthy control group (n = 9), χ2 = 21.71, p < .0005.

Study 2

Research examining the stability of self-structure indices and the extent to which they are amendable to change following psychological therapy in any clinical group is sparse. We were therefore interested in examining stability in our clinical group by assessing whether self-structure indices changed following a 12-week mindfulness-based group intervention. Research is starting to suggest that mindfulness is causally related to paranoia. For example, mindfulness has been found to moderate the

design

A pilot RCT design was used to examine the stability of self-structure following a group mindfulness intervention (see Ellett et al., 2020, for the main findings from the pilot trial reporting feasibility, acceptability, and clinical outcomes). Clinical participants (the same clinical group from Study one) were randomized to either the intervention arm (12-week group mindfulness therapy + TAU) or the control arm (TAU alone). Block randomization was undertaken, using a computerized service from

Results and Discussion

Descriptive statistics on the study measures are summarized in Table 2.

General Discussion

Our two studies make important novel contributions. Study 1 assessed if, and in what ways, self-structure differs between people with persecutory delusions in the context of a schizophrenia spectrum diagnosis and healthy controls. Study 2 explored a related question of whether within the clinical sample, self-structure indices were associated with delusion severity and depression, and whether participation in a group mindfulness-based intervention changed self-structure in individuals with

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    ☆

    This paper presents independent research funded in part by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

    ☆☆

    The authors declare there are no conflicts of interest.

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