title: Current paranoid thinking in patients with delusions: the presence of cognitive-affective biases.
abstract: BACKGROUND
  There has been renewed interest in the influence of affect on psychosis. Psychological research on persecutory delusions ascribes a prominent role to cognitive processes related to negative affect: anxiety leads to the anticipation of threat within paranoia; depressive negative ideas about the self create a sense of vulnerability in which paranoid thoughts flourish; and self-consciousness enhances feelings of the self as a target. The objective of this study was to examine such affective processes in relation to state paranoia in patients with delusions.
  
  
  METHODS
  130 patients with delusions in the context of a nonaffective psychosis diagnosis (predominately schizophrenia) were assessed for contemporaneous levels of persecutory ideation on 5 visual analog scales. Measures were taken of anxiety, depression, threat anticipation, interpretation of ambiguity, self-focus, and negative ideas about the self.
  
  
  RESULTS
  Of the patients, 85% report paranoid thinking at testing. Symptoms of anxiety and depression were highly prevalent. Current paranoid thinking was associated with anxiety, depression, greater anticipation of threat events, negative interpretations of ambiguous events, a self-focused cognitive style, and negative ideas about the self.
  
  
  CONCLUSIONS
  The study provides a clear demonstration that a range of emotion-related cognitive biases, each of which could plausibly maintain delusions, are associated with current paranoid thinking in patients with psychosis. We identified biases both in the contents of cognition and in the processing of information. Links between affect and psychosis are central to the understanding of schizophrenia. We conclude that treatment of emotional dysfunction should lead to reductions in current psychotic experiences.
authors.affiliation: To whom correspondence should be addressed; Oxford Cognitive Approaches to Psychosis, University Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, UK, OX3 7JX; tel: +44 (0) 1865 226490, fax: +44 (0) 1865 793101, e-mail: daniel.freeman@psych.ox.ac.uk.
authors.forename: Daniel
authors.initials: D
authors.lastname: Freeman
authors.forename: Graham
authors.initials: G
authors.lastname: Dunn
authors.forename: David
authors.initials: D
authors.lastname: Fowler
authors.forename: Paul
authors.initials: P
authors.lastname: Bebbington
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kuipers
authors.forename: Richard
authors.initials: R
authors.lastname: Emsley
authors.forename: Suzanne
authors.initials: S
authors.lastname: Jolley
authors.forename: Philippa
authors.initials: P
authors.lastname: Garety
mesh_terms: D000328:Adult; D000339:Affect / Q000502:physiology; D001007:Anxiety / Q000503:physiopathology / Q000523:psychology; D003071:Cognition / Q000502:physiology; D003702:Delusions / Q000503:physiopathology* / Q000523:psychology; D003863:Depression / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012563:Schizophrenia, Paranoid / Q000503:physiopathology*; D012565:Schizophrenic Psychology; D012649:Self Concept; D013850:Thinking / Q000502:physiology; D055815:Young Adult