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How Do Individuals with Persecutory Delusions Bring Worry to a Close? An Interpretive Phenomenological Analysis

  • Helen Startup (a1), Katherine Pugh (a2), Jacinta Cordwell (a3), David Kingdon (a3) and Daniel Freeman (a2)...


Background: Worry is a significant problem for individuals with paranoia, leading to delusion persistence and greater levels of distress. There are established theories concerning processes that maintain worry but little has been documented regarding what brings worry to a close. Aims: The aim was to find out what patients with persecutory delusions report are the factors that bring a worry episode to an end. Method: Eight patients with persecutory delusions who reported high levels of worry participated. An open-ended semi-structured interview technique and IPA qualitative analysis was employed to encourage a broad elaboration of relevant constructs. Results: Analyses revealed one theme that captured participants’ detailed descriptions of their experience of worry and five themes that identified factors important for bringing worry episodes to a close: natural drift, distraction, interpersonal support, feeling better, and reality testing. Conclusions: Patients with persecutory delusions report worry being uncontrollable and distressing but are able to identify ways that a period of worry can stop. The present study suggests that building on individuals’ distraction techniques, reality testing ability and their social support network could be of benefit. Research is needed to identify the most effective means of bringing paranoid worries to an end.


Corresponding author

Reprint requests to Helen Startup, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK. E-mail:


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Bassett, M., Sperlinger, D. and Freeman, D. (2009). Fear of madness and persecutory delusions. Psychosis, 1, 3950.
Bentall, R. and Fernyhough, C. (2008). Social predictors of psychotic experiences: specificity and psychological mechanisms. Schizophrenia Bulletin, 34, 10121020.
Borkovec, T. D., Robinson, E., Pruzinsky, T. and DuPree, J. A. (1983). Preliminary exploration of worry: some characteristics and processes. Behaviour Research and Therapy, 23, 481482.
Chadwick, P., Newman-Taylor, K. and Abba, N. (2005). Mindfulness groups for people with distressing voices. Behavioural and Cognitive Psychotherapy, 33, 351359.
Davey, G. (2006). A Mood-as-input account of perseverative worrying. In Davey, G. and Wells, A. (Eds.), Worry and its Psychological Disorders (Chapter 13). Chichester: Wiley.
Davey, G. and Wells, A. (2006). Worry and its Psychological Disorders. Chichester: Wiley.
Foster, C., Startup, H., Potts, L. and Freeman, D. (2010). A randomised controlled trial of a worry intervention for patients with persistent persecutory delusions. Journal of Behavioural Therapy and Experimental Psychiatry, 41, 4551.
Freeman, D. and Garety, P. (1999). Worry, worry processes and dimensions of delusions. Behavioural and Cognitive Psychotherapy, 27, 4762.
Freeman, D. and Garety, P. A. (2000). Comments on the content of persecutory delusions: does the definition need clarification? British Journal of Clinical Psychology, 39, 407414.
Freeman, D., Dunn, G., Startup, H. and Kingdon, D. (2012). The effects of reducing worry in patients with persecutory delusions: study protocol for a randomised controlled trial. Trials, 13, 233.
Freeman, D., McManus, S., Brugha, T., Meltzer, H., Jenkins, R. and Bebbington, P. (2011). Concomitants of paranoia in the general population. Psychological Medicine, 41, 923936.
Freeman, D., Pugh, K., Antley, A., Slater, M., Bebbington, P., Gittins, M., et al. (2008). A virtual reality study of paranoid thinking in the general population. British Journal of Psychiatry, 192, 258263.
Freeman, D., Pugh, K., Vorontsova, N., Antley, A. and Slater, M. (2010). Testing the continuum of delusional beliefs: an experimental study using virtual reality. Journal of Abnormal Psychology, 119, 8392.
Freeman, D., Stahl, D., McManus, S., Meltzer, H., Brugha, T., Wiles, N., et al. (2012). Insomnia, worry, anxiety and depression as predictors of the occurrence and persistence of paranoid thinking. Social Psychiatry Psychiatric Epidemiology, 47, 11951203.
Garety, P. and Freeman, D. (1999). Cognitive approaches to delusions: a critical review of theories and evidence. British Journal of Clinical Psychology, 38, 113154.
Garety, P. and Freeman, D. (2013). The past and future of delusions research. British Journal of Psychiatry, 203, 327333.
Hawksley, J. and Davey, G. (2010). Mood-as-input and depressive rumination. Behaviour Research and Therapy, 48, 134140.
Hepworth, C., Startup, H. and Freeman, D. (2011). Developing treatments for persistent persecutory delusions: the impact of an emotional processing and metacognitive awareness (EPMA) intervention. Journal of Nervous and Mental Disease, 199, 653658.
Kuper, A., Reeves, S. and Levinson, W. (2008). Qualitative research: an introduction to reading and appraising qualitative research. British Medical Journal, 337, 7666.
Leahy, R. (2006). The Worry Cure: stop worrying and start living. London: Piatkus Books Ltd.
MacDonald, B. and Davey, G. (2005). Inflated responsibility and perseverative checking: the effect of negative mood. Journal of Abnormal Psychology, 114, 176182.
Martin, L. L. and Davies, B. (1998). Beyond hedonism and associationism. Motivation and Emotion, 22, 3351.
Martin, L. L., Ward, D. W., Achee, J. W. and Wyer, R. S. (1993). Mood as input: people have to interpret the motivational implication of their moods. Journal of Personality and Social Psychology, 63, 317326.
Meares, K. and Freeston, M. (2008). Overcoming Worry. London: Constable & Robinson Ltd.
Meeten, F. and Davey, G. (2011). Mood-as-input hypothesis and perseverative psychopathologies. Clinical Psychology Review, 31, 12591275.
Meyer, T. J., Miller, M. L., Metzger, R. L. and Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28, 487495.
Morrison, A. and Wells, A. (2007). Relationships between worry, psychotic experiences and emotional distress in patients with schizophrenia spectrum diagnoses and comparisons with anxious and non-patient groups. Behaviour Research and Therapy, 45, 15931600.
Schwarz, N. and Clore, G. L. (1983). Mood, misattribution, and judgements of well-being: informative and directive functions of affective states. Journal of Personality and Social Psychology, 45, 513523.
Schwarz, N. and Clore, G. L. (2003). Mood as information: 20 years later. Psychological Inquiry, 14 (3–4), 296303.
Smith, J. A. (2004). Reflecting on the development of interpretative phenomenological analysis and its contribution to qualitative psychology. Qualitative Research in Psychology, 1, 3954.
Smith, J. A. and Osborn, M. (2008). Interpretative phenomenological analysis. In Smith, J. A. (Ed.), Qualitative Psychology: a practical guide to research methods (2nd edn). London: Sage Publications.
Startup, H. and Davey, G. (2001). Mood as input and catastrophic worrying. Journal of Abnormal Psychology, 110, 8396.
Startup, H. and Davey, G. (2003). Inflated responsibility and the use of stop rules for catastrophic worrying. Behaviour Research and Therapy, 41, 495503.
Startup, H. M. and Erickson, T. M. (2006). The Penn State Worry Questionnaire (PSWQ). In Davey, G. C. L. and Wells, A., (Eds.), Worry and its Psychological Disorders (pp. 101120). Chichester: Wiley.
Startup, H., Freeman, D. and Garety, P. (2007). Persecutory delusions and catastrophic worry in psychosis: developing the understanding of delusion distress and persistence. Behaviour Research and Therapy, 45, 523537.
Watkins, E. and Mason, A. (2002). Mood-as-input and rumination. Personality and Individual Difference, 32, 577587.
Wells, A. (2006). The metacognitive model of worry and generalised anxiety disorder. In Davey, G. C. L. and Wells, A. (Eds.), Worry and its Psychological Disorders: theory, assessment and treatment. Chichester: John Wiley & Sons Ltd.



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How Do Individuals with Persecutory Delusions Bring Worry to a Close? An Interpretive Phenomenological Analysis

  • Helen Startup (a1), Katherine Pugh (a2), Jacinta Cordwell (a3), David Kingdon (a3) and Daniel Freeman (a2)...
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