Mistrust and negative self-esteem: Two paths from attachment styles to paranoia

Could an evaluative conditioning intervention ameliorate paranoid beliefs? Self-reported and neurophysiological evidence from a brief intervention focused on improving self-esteem

Introduction

Much research on the treatment of paranoia has involved cognitive-behavioural interventions that address explicit social cognition processes. However, much of human cognition is preverbal or implicit, raising the possibility that such social judgements are implicated in paranoia. One type of implicit social cognition that has been investigated concerning paranoia is implicit self-esteem with some evidence that it may be possible to change implicit self-esteem using techniques based on conditioning theory. Therefore, the primary purpose of this research is to further evaluate the potential of this approach. At the same time, as a secondary purpose, we introduce a novel way of measuring social cognition that, we argue, has utility for investigating the psychological processes involved in paranoia.

Method

We conducted two proof-of-concept studies of a novel brief intervention based on evaluative conditioning, targeting implicit cognition. The first study was conducted with a large non-clinical sample, while the second study included a small series of psychotic patients. As part of our proof-of-concept evaluation of the potential of evaluative conditioning, we attempted to probe for neurophysiological changes following the intervention using magnetoencephalography in an exploratory way in the clinical sample.

Results

Our results revealed that both non-clinical and clinical participants in the experimental group showed a significant change in how they evaluated themselves in the social cognition task, which could be related to the perception of social information in a less threatening way. In addition, clinical participants in the experimental group showed changes in brain activity during the social cognition task, particularly in regions involved in emotional reactivity and mentalization processes.

Discussion

Our results are encouraging, suggesting that implicit cognition is manipulable, that such manipulation affects underlying neurophysiological mechanisms, and that there may be an impact on paranoid symptoms. However, much more work is required to determine whether this approach can produce meaningful clinical change and be delivered in routine clinical settings. Finally, it is important to note that we are not claiming the clinical effectiveness of our intervention, which is in a very early stage of development. Our goal here is to demonstrate clinical possibilities that warrant further investigation.

Conspiracy theory beliefs in the adolescent population: A systematic review

INTRODUCTION

While the study of conspiracy theory beliefs is a relatively new research area, there has been a rise in academic interest in recent years. The literature provides evidence of relationships between conspiracy theory beliefs and a range of factors, but the vast majority of studies are limited to adult samples, and it is unclear how such beliefs present in adolescence.

METHODS

The systematic review was conducted according to the PRISMA-S format. Relevant databases were searched up to February 23, 2023, for quantitative studies related to adolescent conspiracy theory beliefs.

RESULTS

The six included articles show that conspiracy theory beliefs are present from the start of adolescence, and stable from age 14 upwards, with correlations reported for mistrust and paranoid thinking. Negative relationships were reported for cognitive factors such as ontological confusion, cognitive ability, and actively open-minded thinking. Health-related beliefs correlated with adverse childhood experiences, peer problems, conduct, and sociodemographic factors. Right-wing authoritarianism and anxiety positively correlated with intergroup conspiracy theory beliefs.

CONCLUSION

While some factors from adult studies are replicated in the review, there are differences between age groups. The age at which conspiracy theory beliefs begin to form indicate developmental aspects of adolescence, and possibly childhood, that require further examination. Cognitive factors show promise for interventions and should be explored further. However, the lack of studies using adolescent populations is an issue that must be resolved for a greater understanding of conspiracy theory beliefs and a move toward effective interventions.

Temporal pathways from attachment insecurity to paranoia in a heterogeneous clinical sample: An experience sampling study

INTRODUCTION

There has been growing interest in the role of attachment mechanisms in the onset and maintenance of paranoia. The latest systematic reviews of mixed samples of healthy individuals and psychiatric patients have revealed that increased trait attachment anxiety and avoidance are associated with experiencing paranoia, with trait attachment anxiety showing a stronger association. Few studies have examined attachment and paranoia in naturalistic conditions via the Experience Sampling Method.

OBJECTIVES

The present study examined whether experiences of attachment anxiety and avoidance fluctuate in the flow of daily life, and whether a within-person change in both attachment states precedes the experience of momentary paranoia, and negative and positive emotions.

METHODS

Thirty-seven clinical participants and twenty-six healthy controls were studied over six consecutive days using the Experience Sampling Method (ESM). An experience-in-close-relationships questionnaire (ECR-R 16 SF) was used to capture trait attachment dimensions. Several ESM items were used to capture momentary negative and positive affect, paranoia and attachment insecurity states.

RESULTS

The findings revealed that fluctuations in both attachment insecurity states were significantly higher in the clinical group. A prior elevated attachment anxiety and avoidance was followed by an increase in negative affect in the next moment and elevated attachment avoidance was additionally followed by a decrease in positive affect and an increase in paranoia.

CONCLUSION

Our findings reveal the specific temporal associations between momentary attachment insecurity states as predictors of change in emotions/affects and paranoia, along with evidence that state attachment avoidance has a superior impact on momentary affect and paranoia compared to state attachment anxiety. These results contrast with those of recent cross-sectional studies.

Self-Esteem Moderates the Relationship Between Secure Attachment and Internalizing and Externalizing Problems in Preadolescence

This longitudinal study examined the interactive effects of secure attachment and self-esteem on change in internalizing and externalizing problems in a sample of preadolescents. 407 youth (M_age = 11.1 years) completed measures of self-esteem, secure attachment style, and peer nomination inventories tapping internalizing and externalizing problems at the beginning of the fourth and fifth grades. Results suggest that internalizing and externalizing problems may be reduced for securely attached youth with high self-esteem. Implications for future research are examined, along with a discussion on clinical applications of studies involving interaction effects.

Identity resilience, science mistrust, COVID-19 risk and fear predictors of vaccine positivity and vaccination likelihood: A survey of UK and Portuguese samples

Based on Identity Process Theory, we hypothesised that two elements of identity resilience (identity worth and identity continuity) differentially predict variance in COVID-19 fear and risk, science mistrust, vaccine positivity, and vaccination likelihood. Data from an online survey of 643 UK and 485 Portuguese adults collected during March 2021 showed the UK and Portuguese did not differ significantly on vaccination likelihood or identity resilience. UK respondents reported less science mistrust, COVID-19 risk, and fear, but higher vaccine positivity than the Portuguese. Identity worth and identity continuity differed between countries in their effects on science mistrust, COVID-19 fear, risk, vaccine positivity and vaccination likelihood. Science mistrust and COVID-19 fear proved key factors in predicting vaccine positivity and vaccination likelihood. We conclude the roles of discrete elements of identity resilience in health behaviour require further examination and action reducing prevalence of specific forms of science mistrust can improve vaccination likelihood.

Bridging the gap between body image and paranoia-like thoughts

A feeling of vulnerability is believed to be one of the foundations upon which paranoia is built. Factors that may increase vulnerability include negative affective states, low self-esteem and high social rejection sensitivity. Body image, which is one aspect of the overall self-esteem, has recently been shown to be associated with paranoia. However, little is known about factors underlying this association. In this online study conducted on a non-clinical sample (n = 539, 65.5% of female), self-report data assessing paranoia-like thoughts, body image, self-esteem, negative emotions, rejection sensitivity as well as various attitudes and beliefs related to body appearance were collected. The results revealed a significant serial mediation effect of negative emotions, self-esteem and rejection sensitivity in the relationship between body image and paranoia-like thoughts. Parallel mediation analysis showed an effect of social criticism as the only one of four studied groups of beliefs related to body appearance in the relationship between paranoia-like thoughts and body image. Moreover, paranoia-like thoughts were increased in people who were not satisfied with their body, both as a result of feeling too thin and overweight. To conclude, body image is an important factor related to paranoia-like thoughts, through its association with increased vulnerability and negative general self-view. The findings highlight the importance of negative emotions, low self-esteem and high rejection sensitivity, as well as the role of critical comments and lack of perceived acceptance as potential (socially-focused) mechanisms paving the way from negative body image to paranoia-like thoughts.

Paranoid beliefs and conspiracy mentality are associated with different forms of mistrust: A three-nation study

Paranoia and conspiracy are terms typically used interchangeably. However, although the underlying content of these types of beliefs might be similar (e.g., seeing others as powerful and threatening), recent research suggests that these constructs differ in important ways. One important feature shared by both constructs is excessive mistrust but this aspect might play different roles in each belief system. In this study we explored the strength of associations of different trust predictors (i.e., trust in institutions, trust in sources of information, perceptual trust, and interpersonal trust) between conspiracy mentality and paranoid beliefs. We tested this association in a large representative multinational sample (United Kingdom n = 2025; Spain n = 1951; and Ireland n = 1041). Confirmatory factor analysis supported a two-factor model of conspiracy and paranoid beliefs in each nation sample. Path and equality of constraints analysis revealed that paranoia was more strongly associated with perceptual mistrust (bias towards mistrusting unfamiliar faces) whereas conspiracy was more strongly associated with mistrust in political institutions. Although interpersonal mistrust and trust in social sources of information were associated significantly with conspiracy their association with paranoid beliefs was stronger. These findings clarify the role of different trust processes in both belief systems. Limitations of this study are discussed.

How does attachment style affect psychosis? A systematic review of causal mechanisms and guide to future inquiry

PURPOSE

The link between attachment and psychosis is now well established, but less is known about the causal mechanisms underlying this relationship. This systematic review synthesises the studies that examine mediating mechanisms in the attachment and psychosis relationship, in both clinical and non-clinical samples.

METHOD

We conducted a database search (PsychINFO, MEDLINE, Web of Science) to identify all eligible studies irrespective of publication status, the language of article or article date. We assessed methodological quality and completed a narrative synthesis given the heterogeneity of studies to date.

RESULTS

We identified 17 papers, comprising 3,672 participants. The relationship between attachment and psychosis is mediated by four variables or groups of variables. There is good evidence for the causal role of affective factors (affective dysregulation and affective disturbances) and cognitive factors (e.g., self-beliefs and self-esteem and beliefs about symptoms). Affective factors differed by attachment style. Tentative evidence was found for the role of duration of untreated psychosis and baseline negative symptoms.

CONCLUSIONS

Cognitive and affective factors mediate the relationship between attachment style and psychosis. Whilst cognitive factors are routinely targeted in recommended psychological interventions for psychosis, affective factors and attachment style are less commonly considered. Psychological therapies may be improved by calibrating cognitive and affective interventions by attachment style, which should be subjected to experimental and then field studies to assess the impact on clinical and recovery outcomes.

PRACTITIONER POINTS

The relationship between attachment and psychosis is now well established, and studies have started to examine mediating mechanisms. Affective and cognitive factors mediate the attachment-psychosis relationship. Affective factors differ by attachment style. There is limited evidence for the duration of untreated psychosis and negative psychotic symptoms as mediating mechanisms, and research replication is needed. Cognitive factors are routinely targeted in recommended psychological therapies for psychosis, but affective factors and attachment style are less commonly considered. Research should be conducted into the effectiveness of psychological therapies which calibrate cognitive and affective interventions, according to attachment style.

How does insecure attachment lead to paranoia? A systematic critical review of cognitive, affective, and behavioural mechanisms

Background

The relationship between attachment and paranoia is now well established. There is good theoretical reason and evidence to indicate that attachment style affects cognitive, affective, and behavioural processes which, in turn, contribute to the maintenance of paranoia, but this research has not been integrated. We critically and systematically review research that examines relevant cognitive, affective, and behavioural processes, which may explain how attachment insecurity leads to paranoia and constitute key targets in psychotherapeutic interventions for people with psychosis.

Method

We conducted three systematic searches across six databases (PsycINFO, CINAHL, Medline, Web of Science, Embase, and Google Scholar), from inception to September 2021, to investigate key cognitive, affective, and behavioural processes in the attachment–paranoia association.

Results

We identified a total of 1930 papers and critically reviewed 16. The literature suggests that negative self‐ and other‐beliefs, inability to defuse from unhelpful cognitions, and use of maladaptive emotion regulation strategies mediate the association between attachment insecurity and paranoia in people with psychosis/psychotic experience. Attachment‐secure people with psychosis are more likely to seek help and engage with services than attachment‐insecure people.

Conclusions

Attachment styles impact help‐seeking behaviours in people with psychosis and are likely to influence paranoia via self‐ and other‐beliefs, cognition fusion, and emotion regulation – these candidate mechanisms may be targeted in psychological therapy to improve clinical outcomes for people with psychosis, characterized by paranoia.

Practitioner points

Insecure attachment is likely to lead to paranoia via negative beliefs about self and others, cognitive fusion, and use of maladaptive emotion regulation strategies. These mechanisms can be targeted in psychotherapeutic interventions for psychosis, such as cognitive behaviour therapy, to improve clinical and recovery outcomes.

People with psychosis who are attachment‐secure are more likely to seek help and engage with services than those who are attachment‐insecure (particularly avoidant). Attachment style can be assessed to predict service engagement and help‐seeking behaviours in people with psychosis.

Attachment styles are important predictors of key cognitive, affective, and behavioural processes in people with psychosis. These processes can be assessed and incorporated into individualised formulations, and then targeted in therapy to effect psychotherapeutic change.