title: Worry processes in patients with persecutory delusions.
abstract: OBJECTIVE
  Worry may be common in patients with paranoia and a contributory causal factor in the occurrence of the delusions. A number of psychological mechanisms have been linked to the occurrence of worry in emotional disorders but these are yet to be investigated in psychosis. The primary aim of the study was to test the links between five main worry mechanisms - perseverative thinking, catastrophizing, stop rules, metacognitive beliefs, and intolerance of uncertainty - and the cognitive style of worry in patients with persecutory delusions.
  
  
  METHODS
  One hundred and fifty patients with persecutory delusions completed assessments of paranoia, worry, and worry mechanisms.
  
  
  RESULTS
  Worry in patients with psychosis was associated with the following: a perseverative thinking style, an 'as many as can' stop rule, a range of metacognitive beliefs (cognitive confidence, worry as uncontrollable and the need to control thoughts), and intolerance of uncertainty. Higher levels of worry were associated with higher levels of paranoia. There was also evidence that intolerance of uncertainty and the metacognitive belief concerning the need to control thoughts were independently associated with paranoia.
  
  
  CONCLUSIONS
  Worry in patients with persecutory delusions may well be understood by similar underlying mechanisms as worry in emotional disorders. This supports the use of interventions targeting worry, suitably modified, for patients with psychosis.
  
  
  CONCLUSIONS
  Worry is a significant concern for patients with paranoia Worry in paranoia is likely to be caused by similar mechanisms as worry in emotional disorders The results support the recent trial findings that standard techniques for treating worry in anxiety, suitably modified, are applicable for patients with paranoia LIMITATIONS: The findings are limited by the self-report nature of measures and by the study design which precludes any assumptions about the direction of causality between the psychological mechanisms and worry.
authors.affiliation: Department of Psychiatry, University of Oxford, UK. helen.startup@kcl.ac.uk.|Sussex Partnership NHS Foundation Trust, West Sussex, UK. helen.startup@kcl.ac.uk.
authors.forename: Helen
authors.initials: H
authors.lastname: Startup
authors.affiliation: Department of Psychiatry, University of Oxford, UK.|Sussex Partnership NHS Foundation Trust, West Sussex, UK.
authors.forename: Katherine
authors.initials: K
authors.lastname: Pugh
authors.affiliation: Centre for Biostatistics, Institute of Population Health, University of Manchester, UK.|MRC NW Hub for Trials Methodology Research.
authors.forename: Graham
authors.initials: G
authors.lastname: Dunn
authors.affiliation: Academic Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK.
authors.forename: Jacinta
authors.initials: J
authors.lastname: Cordwell
authors.affiliation: Academic Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Mander
authors.affiliation: Department of Psychiatry, University of Oxford, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Černis
authors.affiliation: Academic Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK.
authors.forename: Gail
authors.initials: G
authors.lastname: Wingham
authors.affiliation: Academic Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK.
authors.forename: Katherine
authors.initials: K
authors.lastname: Shirvell
authors.affiliation: Academic Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK.
authors.forename: David
authors.initials: D
authors.lastname: Kingdon
authors.affiliation: Department of Psychiatry, University of Oxford, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Freeman
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000523:psychology*; D058443:Catastrophization / Q000523:psychology; D003702:Delusions / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D000067489:Metacognition; D010259:Paranoid Disorders / Q000523:psychology*; D011618:Psychotic Disorders / Q000523:psychology*; D057566:Self Report; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013850:Thinking; D035501:Uncertainty
keywords: anxiety; intolerance of uncertainty; persecutory delusions; psychosis; schizophrenia; worry