Persecutory delusions: developing the understanding of belief maintenance and emotional distress

Background. The objective of the study was to develop the cognitive underst anding of persecutory delusions. It was hypothesized that safety behaviours contribute to the persistence of persecutory delusions by preventing disco nfirmation. It was further hypothesized that emotional distress is associat ed with aspects of the content of delusions. An investigation was designed to establish whether individuals with persecutory delusions use safety beha viours, and to test predicted associations between delusion content and emo tional distress. Method. A cross-sectional investigation was conducted on 25 individuals wit h persecutory delusions. A detailed assessment was made of the presence of safety behaviours, the content of delusions and emotional distress. Results. All participants had used at least one safety behaviour in the las t month, most typically avoidance. Higher levels of anxiety were associated with greater use of safety behaviours. New data were obtained on the conte nt of persecutory delusions. Aspects of the content of the delusions were a ssociated with levels of depression, self-esteem, anxiety and delusional di stress. Conclusions. Individuals with persecutory delusions use safety behaviours. The findings may develop the understanding of delusion persistence, acting upon delusions and the negative symptoms of schizophrenia. There are implic ations for cognitive interventions for psychosis. Support was also found fo r the hypothesis that emotional distress is linked to the content of delusi onal beliefs; it is speculated that prior emotional distress influences the content of delusions, and that delusion content in turn influences levels of emotional distress.