Trower and Chadwick (1995) argued that there are two types of paranoia: 'poor me', in which persecution is seen as undeserved, and 'bad me', in which it is perceived to be deserved. These authors outlined a theory which accounts for both types of paranoia and makes predictions regarding their stability. To investigate the phenomenology of deservedness of persecution in both clinical and non-clinical populations (i.e. categorically vs. dimensionally distributed; changeable vs. stable over time), and to examine whether different degrees of deservedness are associated with different psychological constructs and cognitive processes, as predicted by the different accounts of paranoia, (ii) To devise a new measure that assesses both the severity of paranoia and its deservedness in clinical and non clinical populations.

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Attributional models of persecutory delusions suggest that paranoia arises when people make excessively external attributions for negative events and excessively internal attributions for positive events (i.e. people blame negative events on other people or circumstances and attribute positive events to themselves). The results from a review of the literature on attributional style in people with persecutory delusions indicated that that the evidence for an externalising bias, and more specifically an externalising-personal bias, for negative events is inconsistent and the evidence for an internalising bias for positive events is minimal. More consistent findings were obtained for external- situational attributions; people with persecutory delusions make fewer attributions of this type for negative events compared with healthy controls. The evidence also tentatively suggests that the attributional style of people with persecutory delusions fluctuates momentarily and with the course of mental illness. These findings are discussed in relation to issues with the reliability of current measures of attributional style. Keywords: paranoid delusions, persecutory delusions, attributional style, explanatory style, review Highlights • The evidence for attributional biases in persecutory delusions is inconsistent. Paranoid people make few external-situational attributions for negative events. Attributional style might be unstable in people with persecutory delusions. • • ATTRIBUTIONAL STYLE AND PERSECUTORY DELUSIONS • The reliability of current measures of attributional style is poor. 3

It is thought that experiential avoidance (EA), conceptualised as avoidance of unpleasant mental experiences, lies at the heart of psychopathology. The studies included into this thesis investigated the role of EA in the paranoid process using a range of methodologies (experience sampling, questionnaire and experimental) in patient and nonclinical populations. Part of this thesis explored the dynamic relationships between paranoia, self-esteem and EA using the Experience Sampling Method (ESM), a structured diary technique which allows the assessment of symptoms, mood and behaviour in the context of daily life. This thesis also examined the role of early experiences with parents in the paranoid process and explored developmental roots of EA. Finally, it examined the use of avoidant strategies in nonclinical and patient populations using both questionnaire and behavioural measures of EA. The data collected suggest that paranoid individuals are highly intolerant of unpleasant mental states and habitually engage in attempts to avoid them. The results indicate that avoidance may be particularly successful in paranoid patients who believe that their persecution is underserved. There was some evidence that although avoidant strategies may be fruitful when cognitive demands are relatively low, their success is significantly compromised by the additional demands leaving paranoid individuals vulnerable to stress. Finally, the results ofthis thesis also indicate that the roots of EA can be traced to early experiences with parents and suggest that suboptimal parenting may foster EA and paranoid thinking later in life. These results are compatible with the attributional model of paranoia which suggests that persecutory delusions arise a result of dysfunctional attempts to avoid unpleasant thoughts about the self. They highlight the dynamic nature of psychological processes involved in paranoia and suggest that psychological interventions targeting EA may alleviate paranoia. 11

Paranoid-like cognitions are common in the general population and can be triggered by heightened self-awareness plus failure feedback. One interpretation of this effect, based on clinical models of paranoia, is that these conditions pose a threat to one's self- . esteem, which in turn triggers paranoid-like cognitions. Cross-sectionally, this study assessed: (a) the construct validity (convergent validity: trait paranoia and public self- consciousness; discriminant validity: social anxiety) of the paranoia-induction procedures (heightened self-awareness plus failure feedback) and (b) the mechanisms involved in triggering paranoid-like cognitions under these conditions. Experimentally, this study also assessed ( c) whether affirming a valued domain attenuates paranoid -like cognitions. Using a mixed experimental design, university students (N=58) were randomised to a self-affirmation or non-affirmation control condition before exposure to the paranoia- induction task. State paranoia, self-esteem, mood and self-awareness were measured at baseline, post-affirmation, and after the paranoia-induction task. Trait paranoia, public self-consciousness and social anxiety were measured at baseline. Contrary to prediction, all trait variables were unrelated to changes in state paranoia during the paranoia-induction task. However, cross-sectional analyses of changes in state measures during the paranoia-induction task were consistent with prediction: the paranoia-induction task affected an increase in public self-awareness, which was associated with a reduction in self-esteem. Reductions in self-esteem were associated with higher levels of state paranoia following the paranoia-induction task. Affirming a 3 valued domain reduced state paranoia, but did not affect a change in reactivity to the paranoia-induction task. In conclusion, paranoid-like cognitions did increase during the paranoia-induction task (Ellett & Chadwick, 2007); however, the extent to which these experiences are reminiscent of naturally occurring paranoia remains to be established. Cross-sectional analyses suggested that reductions in self-esteem are associated with state paranoia following the task, but the direction of causation cannot be determined. Self-affirmation did reduce paranoid-like cognitions, but did not alter reactivity to the paranoia-induction task.

A growing body of research shows that paranoia is common in the general population. This thesis reports two studies that examined the Prisoner's Dilemma Game (PDG) as a paradigm for evaluation of nonclinical paranoia. The PDG is a well-validated paradigm, used widely in social psychological research but only used in one study to date to examine paranoia. The PDG captures three key qualities that are at the heart of paranoia - it is interpersonal, it concerns threat, and it concerns perception of others' intentions towards the self. The aim of Study 1 was to investigate whether the PDG captures the interpersonal nature of paranoia specifically. Study 1 found that higher state paranoia was significantly associated with selection of the competitive PDG choice in a nonclinical population (n=110). Crucially, state paranoia was only significantly associated with competitive PDG choice when participants believed that they were playing the PDG against another person, and not when playing against a computer, confirming the interpersonal nature of the association. The aim of Study 2 was to investigate if fear, which is " relevant to paranoia, motivated the choice to compete on the PDG in those experiencing elevated levels of paranoia. In Study 2, we used a self-report questionnaire to assess fear and greed, in addition to state paranoia in a nonclinical population (n=149). Higher state paranoia was associated with competition on the PDG based on fear (but not with competition based on greed). It was concluded that the PDG paradigm does capture the essential interpersonal nature of paranoia and is a useful methodology for studying nonclinical paranoia. 3

This thesis investigates quality of reasoning within non-clinical paranoia and mental simulation of future paranoia themed events by use of a simulation task methodology. This task allows access into online thinking and reasoning and produces a measure of quality and ease in reasoning about paranoia themed material. Two alternative and contradictory hypotheses were tested. First, the expert hypothesis predicted that a proposed preoccupation with paranoid fears may result in an enhanced or expert level of reasoning on situations relating to personal fears within paranoia. Alternatively, due to reasoning biases and difficulty in constructing non-hostile explanations for events, performance may instead be reduced or restricted. Sixty-three participants, recruited from a student population, comprised three groups - a group scoring high in paranoia, a group scoring high for social anxiety, and a group scoring low in both areas. Participants were asked to simulate responses to incomplete paranoia and social anxiety themed scenarios, either personal or non- personal to individual concerns, by giving a step-by-step verbal response of what occurred in the missing part of the scenario. The results indicated that the paranoia group was neither expert nor restricted in their ability to reason through and simulate on a paranoia themed scenario relevant to personal concerns, and neither the expert nor restricted hypotheses could be supported. The social anxiety group, however, showed greater simulation ability on the social anxiety scenario, providing some support for the expert hypothesis. Additionally, simulation ability was related to increased subjective probability for the outcome of the situation, but only when the situation was personal or relevant to individual concerns. 3 - ) The non-clinical paranoia and social anxiety groups appeared to be acting as distinct groups. Simulation and expertise may be different for paranoia than for emotional disorders, and a preoccupation with paranoid fears may not necessarily be associated with enhanced ability in reasoning about relevant feared material. 4 ,

Persecutory delusions are one of the most prevalent psychotic symptoms and research into their causes and consequences is vital. People with 'bad me' paranoia believe they deserve to be persecuted. However, other beliefs associated with this experience have not been identified. Responsibility and overestimation of threat beliefs were traditionally linked with OeD but have also been found in people with unspecified psychosis. The current study examined if there was a difference between responsibility beliefs (separate from overestimation of threat beliefs) in people with persecutory delusions compared to non-clinical controls and previously published data from people with OeD, anxiety disorders and unspecified psychosis. The relationship between responsibility beliefs and deservedness for persecution was also examined. 30 people with persecutory delusions and 29 non-clinical controls were recruited. Both groups completed measures of affect, responsibility and overestimation of threat beliefs. People with persecutory delusions were interviewed about their delusional beliefs and they identified a range of entities who they believed ,. were responsible for the perceived harm. They also had higher responsibility scores than non-clinical controls, people with OeD and people with anxiety disorders. In the persecutory delusions group higher responsibility scores were related to people believing they deserved to be persecuted. However, there was no difference between their responsibility scores and those of people with unspecified psychosis. The results suggest that responsibility beliefs are not specific to OeD but further research is required to establish whether responsibility beliefs have a specific relationship to persecutory delusions or are related to psychosis in general. It is important to assess who people believe is responsible for their persecution as this could identify additional beliefs and experiences that are significant for that individual. Treatments 3 for reducing responsibility beliefs in QeD could be beneficial for people with persecutory delusions and future research is needed to establish this.

Paranoia is a common experience in the non-clinical population (e.g. Freeman et al., 2011) and is significantly associated with distress (e.g. Ellett et al., 2003). A number of experimental approaches have investigated the induction of state paranoia under controlled conditions (e.g. Bodner & Mikulincer, 1998; Ellett & Chadwick, 2007). There has been no investigation into ways of reducing state paranoia once induced, but mindfulness is one possibility. A number of studies have investigated the use of brief mindful self-focus (BMSF) in reducing negative affect following, or preceded by, negative mood induction (e.g. Broderick, 2005; Singer & Dobson, 2007). However, there has been no such experimental exploration of BMSF following paranoia induction. In the present study, a sample of university students first underwent a paranoia induction paradigm (Ellett & Chadwick, 2007) intended to increase state paranoia. Participants were then randomly allocated to one of two conditions: BMSF or Distraction. Both conditions required participants to listen to a brief audio recording. Participants completed trait measures, as well as a set of state measures across three time points (baseline, post paranoia induction, post BMSF/Distraction) to detect change. Findings indicated that participants became significantly more paranoid following the paranoia induction paradigm and that state paranoia was significantly associated with trait paranoia. There was a significant reduction in state paranoia and negative affect following both the BMSF and distraction conditions. State mindfulness did not significantly increase in the BMSF condition, although there was a trend with participants in the BMSF condition demonstrating a higher level of decentring than the distraction condition. BMSF might therefore be a suitable technique for reducing state paranoia in the non-clinical population. Future research could explore other possible mechanisms of change by which mindfulness may reduce state paranoia, and apply BM SF within other populations experiencing paranoia.

Paranoia has frequently been identified as common and distressing. The current study has two main aims: I) to replicate and extend the experimental paradigm previously found to induce state paranoia in students and 2) to determine whether, once activated, . state paranoia can be effectively alleviated by a mood induction intervention. The paradigm involved participants being exposed to an environment of high self-awareness manipulated by application of video camera and television screen and received failure feedback on their performance of a task. Participants were subsequently randomised to either positive or neutral mood inductions. State paranoia, self-awareness and mood were measured at baseline, post-paranoia induction and post-mood induction. Participants also completed trait measures of self-consciousness, negative other beliefs, depression, anxiety and paranoia. As predicted, the experimental setting was found to induce a significant increase in both state paranoia and self-awareness. The positive mood induction was found to significantly increase state positive mood, but the neutral mood induction was found to reduce positive mood state. State paranoia was found to reduce following both mood inductions. No difference between the mood induction groups was found for state paranoia. Trait paranoia and negative beliefs about others were significantly associated with levels of state paranoia post-paranoia induction. A trend was found between state paranoia and self-consciousness. Results suggest that state paranoia could effectively be alleviated by a mood induction intervention however this was not exclusive to type of mood induced. Both mood inductions seemed to be linked to a significant decrease in state self-awareness which could possibly be linked to the reduction in paranoia. It appears that people with high levels of trait paranoia and 3 negative beliefs about others may be predisposed to experiencing state paranoia in this particular environment. Clinical implications of these findings and possibilities for further research will be discussed. 4