Skip to main content Accessibility help

The Fear of Others: A Pilot Study of Social Anxiety Processes in Paranoia

  • Katherine Newman Taylor (a1) and Luisa Stopa (a1)


Background and Aims: There is good reason to consider the role of social anxiety processes in paranoia; both the research and clinical literature indicate significant overlap between the two presentations. The aim of this study was to explore cognition and behaviour that are typically associated with social phobia, in people with paranoia, and then to draw out theoretical and clinical implications. Method: We used a cross-sectional between-subjects design to compare participants with persecutory delusions (without social phobia), social phobia, a clinical control group with panic disorder, and a non-clinical control group. Ten to 15 people were recruited to each of four groups, with a final total of 48 participants. Each person completed measures of automatic thoughts, underlying assumptions, core beliefs and behaviour, and took part in a semi-structured interview designed to assess process (self-consciousness and attentional focus) and metacognitive beliefs. Results: Surprisingly, measures of cognition and behaviour yielded no systematic differences between people with persecutory delusions and social phobia. Conclusions: People with persecutory delusions may experience overt and underlying cognition typically associated with social phobia, and behave in similar ways in response to perceived social threat. These initial results indicate: (i) that larger scale research is now warranted in order to draw firm conclusions about social anxiety processes in paranoia; (ii) more specific hypotheses to be tested; and (iii) a clinical model of paranoia, based on the cognitive model of social phobia, which might now usefully be validated.


Corresponding author

Reprint requests to Katherine Newman Taylor, University of Southampton, UK. E-mail:


Hide All
Amir, N., Foa, E. B. and Coles, M. (1998). Automatic activation and strategic avoidance of threat relevant information in Social Phobia. Journal of Abnormal Psychology, 107, 285290.
Amir, N., Freshman, M. and Foa, E. (2002). Enhanced Stroop interference for threat in social phobia. Journal of Anxiety Disorders, 16, 19.
Bell, V., Halligan, P. W. and Ellis, H. D. (2006). The Cardiff Anomalous Perceptions Scale (CAPS): a new validated measure of anomalous perceptual experience. Schizophrenia Bulletin, 32, 366377.
Bentall, R. P., Corcoran, R., Howard, R., Blackwood, N. and Kinderman, P. (2001). Persecutory delusions: a review and theoretical integration. Clinical Psychology Review, 21, 11431192.
Bentall, R. P., Kaney, S. and Bowen-Jones, K. (1995). Persecutory delusions and recall of threat-related, depression-related, and neutral words. Cognitive Therapy and Research, 19, 445457.
Bentall, R. P., Kaney, S. and Dewey, M. E. (1991). Paranoia and social reasoning: an attribution theory analysis. British Journal of Clinical Psychology, 30, 1323.
Bentall, R. P., Kinderman, P. and Kaney, S. (1994). The self, attributional processes and abnormal beliefs: towards a model of persecutory delusions. Behaviour Research and Therapy, 32, 331341.
Bogels, S. M. and Mansell, , , W. (2004). Attention processes in the maintenance and treatment of social phobia: hypervigilance, avoidance and self-focused attention. Clinical Psychology Review, 24, 827856.
Cassano, G., Pini, S., Saettoni, M., Rucci, P. and Dell'Osso, L. (1998). Occurrence and clinical correlates of psychiatric comorbidity in patients with psychotic disorders. Journal of Clinical Psychiatry, 59, 6068.
Chadwick, P. D. J., Trower, P. and Dagnan, D. (1999). Measuring negative person evaluations: the Evaluative Beliefs Scale. Cognitive Therapy and Research, 23, 549559.
Clark, D. M. (1988). A cognitive model of panic attacks. In Rachman, S. and Maser, J. (Eds.), Panic: psychological perspectives. Hillsdale, NJ: Erlbaum.
Clark, D. M. (1999). Anxiety disorders: why they persist and how to treat them. Behaviour Research and Therapy, 37, S527.
Clark, D. M. (2001). Social Attitudes Questionnaire, revised. Unpublished manuscript: University of Oxford.
Clark, D. M., Ehlers, A., Hackmann, A., McManus, F., Fennell, M., Grey, N., et al. (2006). Cognitive therapy versus exposure and applied relaxation in social phobia: a randomized control trial. Journal of Consulting and Clinical Psychology, 74, 568578.
Clark, D. M. and Wells, A. (1995). A cognitive model of social phobia. In Heimberg, R. G., Liebowitz, M. R., Hope, D. A. and Schneier, F. R. (Eds.), Social Phobia: diagnosis, assessment and treatment. New York: Guilford Press.
Combs, D. R. and Penn, D. L. (2004). The role of sub-clinical paranoia on social perception and behavior. Schizophrenia Research, 69, 93104.
Cossoff, S. J. and Hafner, R. J. (1998). The prevalence of comorbid anxiety in schizophrenia, schizoaffective disorder and bipolar disorder. Australian and New Zealand Journal of Psychiatry, 32, 6772.
Derogatis, L. R. (1994). SCL-90-R: administration, scoring and procedures manual. Minneapolis: National Computer Systems, Inc.
Fear, C., Sharp, H. and Healy, D. (1996). Cognitive processes in delusional disorders. British Journal of Psychiatry, 168, 6171.
Fenigstein, A. and Vanable, P. A. (1992). Paranoia and self consciousness. Journal of Personality and Social Psychology, 62, 129138.
First, M. B., Spitzer, R. L., Gibbon, M. and Williams, J. B. W. (2001). Structured Clinical Interview for DSM-IV-TR Axis I Disorders – Patient Edition (SCID –I/P, 2/2001 revision). New York: Biometrics Research Department, New York State Psychiatric Institute.
Fowler, D., Freeman, D., Smith, B., Kuipers, E., Bebbington, P., Bashforth, H., et al. (2006). The Brief Core Schema Scales (BCSS): psychometric properties and associations with paranoia and grandiosity in non-clinical and psychosis samples. Psychological Medicine, 36, 749759.
Freeman, D. (2006). Delusions in the non-clinical population. Current Psychiatry Reports, 8, 191204.
Freeman, D. and Garety, P. A. (1999). Worry, worry processes and dimensions of delusions: an exploratory investigation of a role for anxiety processes in the maintenance of delusional distress. Behavioural and Cognitive Psychotherapy, 27, 4762.
Freeman, D. and Garety, P. A. (2000). Comments of the content of persecutory delusions: does the definition need clarification? British Journal of Clinical Psychology, 39, 407414.
Freeman, D. and Garety, P. A. (2004). Paranoia: the psychology of persecutory delusions. Hove: Psychology Press.
Freeman, D., Garety, P. A., Bebbington, P. E., Smith, B., Rollinson, R. and Fowler, D. (2005) Psychological investigation of the structure of paranoia in a non-clinical population. British Journal of Psychiatry, 186, 427435.
Freeman, D., Garety, P. A. and Kuipers, E. (2001). Persecutory delusions: developing the understanding of belief maintenance and emotional distress. Psychological Medicine, 31, 12931306.
Freeman, D., Garety, P. A., Kuipers, E., Fowler, D. and Bebbington, P. E. (2002). A cognitive model of persecutory delusions. British Journal of Clinical Psychology, 41, 331347.
Freeman, D., Gittins, M., Pugh, K., Antley, A., Slater, M. and Dunn, G. (2008). What makes one person paranoid and another person anxious? The differential prediction of social anxiety and persecutory ideation in an experimental situation. Psychological Medicine, 38, 11211132.
Frith, C. D. (1992). The Cognitive Neuropsychology of Schizophrenia. Hillsdale, NJ: Lawrence Erlbaum Associates.
Garety, P. A. and Freeman, , , D. (1999). Cognitive approaches to delusions: a critical review of theories and evidence. British Journal of Clinical Psychology, 38, 113154.
Garety, P. A., Hemsley, D. R. and Wessely, S. (1991). Reasoning in deluded schizophrenic and paranoid patients. Journal of Nervous and Mental Disease, 179, 194201.
Hackmann, A., Clark, D. M. and McManus, F. (2000). Recurrent images and early memories in social phobia. Behaviour Research and Therapy, 38, 601610.
Hackmann, A., Surawy, C. and Clark, D. M. (1998). Seeing yourself through others’ eyes: a study of spontaneously occurring images in social phobia. Behavioural and Cognitive Psychotherapy, 26, 312.
Hofmann, S. G. (2007). Cognitive factors that maintain social anxiety disorder: a comprehensive model and its treatment implications. Cognitive Behaviour Therapy, 36, 193209.
Johns, L. C., Cannon, M., Singleton, N., Murray, R. M., Farrell, M., Brugha, T., et al. (2004). Prevalence and correlates of self-reported psychotic symptoms in the British population. British Journal of Psychiatry, 185, 298305.
Johns, L. C. and van Os, J. (2001). The continuity of psychotic experiences in the general population. Clinical Psychology Review, 21, 11251141.
MacKinnon, K., Newman-Taylor, K. and Stopa, L. (2010). Persecutory delusions and the self: an investigation of implicit and explicit self-esteem. Journal of Behavior Therapy and Experimental Psychiatry, 42, 5464.
Mattick, R. P. and Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455470.
McKay, R., Langdon, R. and Coltheart, M. (2007). The defensive function of persecutory delusions: an investigation using the Implicit Association Test. Cognitive Neuropsychiatry, 12, 124.
Michail, M. and Birchwood, M. (2009). Social anxiety disorder in first-episode psychosis: incidence, phenomenology and relationship with paranoia. British Journal of Psychiatry, 195, 234241.
Moorhead, S., Samarasekera, N. and Turkington, D. (2005). Schemas, psychotic themes and depression: a preliminary investigation. Behavioural and Cognitive Psychotherapy, 33, 115117.
Moritz, S., Werner, R. and von Collani, G. (2006) The inferiority complex in paranoia readdressed: a study with the Implicit AssociationTest. Cognitive Neuropsychiatry, 11, 402415.
Morrison, A. P. (2001). The interpretation of intrusions in psychosis: an integrative cognitive approach to psychotic symptoms. Behavioural and Cognitive Psychotherapy, 29, 257276.
Morrison, A. P., Beck, A. T., Glentworth, D., Dunn, H., Reid, G. S., Larkin, W., et al. (2002). Imagery and psychotic symptoms: a preliminary investigation. Behaviour Research and Therapy, 40, 10531062.
Mykletun, A., Stordal, E. and Dahl, A. A. (2001). Hospital Anxiety and Depression Scale: factor structure, item analyses and internal consistency. British Journal of Psychiatry, 179, 540544.
Newman Taylor, K., Graves, A. and Stopa, L. (2009). Strategic cognition in paranoia: the use of thought control strategies in a non-clinical population. Behavioural and Cognitive Psychotherapy, 37, 2538.
Norton, P. J. and Hope, D. A. (2001). Kernels of truth or distorted perceptions: self and observer ratings of social anxiety and performance. Behavior Therapy, 32, 765786.
Olin, S. S. and Mednick, S. A. (1996). Risk factors of psychosis: identifying vulnerable populations premorbidly. Schizophrenia Bulletin, 22, 223240.
Pishyar, R., Harris, L. M. and Menzies, R. G. (2004). Attentional bias for words and faces in social anxiety. Anxiety, Stress, and Coping, 17, 2336.
Rapee, R. M. and Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35, 741756.
Rapee, R. M. and Lim, L. (1992). Discrepancy between self- and observer ratings of performance in social phobics. Journal of Abnormal Psychology, 101, 728731.
Rector, N. A. (2004). Dysfunctional attitudes and symptom expression in schizophrenia: differential associations with paranoid delusions and negative symptoms. Journal of Cognitive Psychotherapy, 18, 163173.
Scheier, M. F. and Carver, C. S. (1985). Optimism, coping, and health: assessment and implications of generalized outcome expectancies. Health Psychology, 4, 219247.
Spector, I. P., Pecknold, J. C. and Libman, E. (2003). Selective attentional bias related to the noticeability aspect of anxiety symptoms in generalized social phobia. Journal of Anxiety Disorders, 17, 517531.
Stopa, L. (1995). Cognitive Processes in Social Anxiety. Unpublished doctoral dissertation, University of Oxford.
Stopa, L. and Clark, D. M. (1992). Cognitive processes in social phobia. Behaviour Research and Therapy, 31, 255267.
Stopa, L. and Clark, , , D. M. (2000). Social phobia and the interpretation of social events. Behaviour Research and Therapy, 38, 273283.
Stopa, L., Denton, R., Wingfield, M. and Newman Taylor, K. (in press). The fear of others: a qualitative analysis of interpersonal threat in social phobia and paranoia. Behavioural and Cognitive Psychotherapy.
Taylor, S. and Wald, J. (2003). Expectations and attributions in social anxiety disorder: diagnostic distinctions and relationship to general anxiety and depression. Cognitive Behaviour Therapy, 32, 166178.
Teasdale, J. D., Moore, R. G., Hayhurst, H., Pope, M., Williams, S. and Segal, Z. V. (2002). Metacognitive awareness and prevention of relapse in depression: empirical evidence. Journal of Consulting and Clinical Psychology, 70, 275287.
Trower, P. and Chadwick, P. D. J. (1995). Pathways to defence of the self: a theory of two types of paranoia. Clinical Psychology: Science and Practice, 2, 263277.
Wells, A. (2000) Emotional Disorders and Metacognition: innovative cognitive therapy. Chichester: Wiley.
Wells, A., Stopa, L. and Clark, D. M. (1993). The Social Cognitions Questionnaire. Unpublished.
Zigmond, A. S. and Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361370.


Related content

Powered by UNSILO

The Fear of Others: A Pilot Study of Social Anxiety Processes in Paranoia

  • Katherine Newman Taylor (a1) and Luisa Stopa (a1)


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.

The Fear of Others: A Pilot Study of Social Anxiety Processes in Paranoia

  • Katherine Newman Taylor (a1) and Luisa Stopa (a1)
Submit a response


No Comments have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *