title: Negative cognition, affect, metacognition and dimensions of paranoia in people at ultra-high risk of psychosis: a multi-level modelling analysis.
abstract: BACKGROUND
  Paranoia is one of the commonest symptoms of psychosis but has rarely been studied in a population at risk of developing psychosis. Based on existing theoretical models, including the proposed distinction between ‘poor me’ and ‘bad me’ paranoia, we aimed to test specific predictions about associations between negative cognition, metacognitive beliefs and negative emotions and paranoid ideation and the belief that persecution is deserved (deservedness).
  
  
  METHODS
  We used data from 117 participants from the Early Detection and Intervention Evaluation for people at risk of psychosis (EDIE-2) trial of cognitive–behaviour therapy, comparing them with samples of psychiatric in-patients and healthy students from a previous study. Multi-level modelling was utilized to examine predictors of both paranoia and deservedness, with post-hoc planned comparisons conducted to test whether person-level predictor variables were associated differentially with paranoia or with deservedness.
  
  
  RESULTS
  Our sample of at-risk mental state participants was not as paranoid, but reported higher levels of ‘bad-me’ deservedness, compared with psychiatric in-patients. We found several predictors of paranoia and deservedness. Negative beliefs about self were related to deservedness but not paranoia, whereas negative beliefs about others were positively related to paranoia but negatively with deservedness. Both depression and negative metacognitive beliefs about paranoid thinking were specifically related to paranoia but not deservedness.
  
  
  CONCLUSIONS
  This study provides evidence for the role of negative cognition, metacognition and negative affect in the development of paranoid beliefs, which has implications for psychological interventions and our understanding of psychosis.
authors.forename: A P
authors.initials: AP
authors.lastname: Morrison
authors.forename: N
authors.initials: N
authors.lastname: Shryane
authors.forename: D
authors.initials: D
authors.lastname: Fowler
authors.forename: M
authors.initials: M
authors.lastname: Birchwood
authors.forename: A I
authors.initials: AI
authors.lastname: Gumley
authors.forename: H E
authors.initials: HE
authors.lastname: Taylor
authors.forename: P
authors.initials: P
authors.lastname: French
authors.forename: S L K
authors.initials: SL
authors.lastname: Stewart
authors.forename: P B
authors.initials: PB
authors.lastname: Jones
authors.forename: S W
authors.initials: SW
authors.lastname: Lewis
authors.forename: R P
authors.initials: RP
authors.lastname: Bentall
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000523:psychology*; D003071:Cognition; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D055361:Multilevel Analysis; D010259:Paranoid Disorders / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000523:psychology*; D012307:Risk Factors; D013334:Students; D055815:Young Adult