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Developing Treatments of Persistent Persecutory Delusions: The Impact of an Emotional Processing and Metacognitive Awareness Intervention

Hepworth, Claire PhD, DClinPsy*; Startup, Helen DPhil, DClinPsy*; Freeman, Daniel PhD, DClinPsy

The Journal of Nervous and Mental Disease: September 2011 - Volume 199 - Issue 9 - p 653-658
doi: 10.1097/NMD.0b013e318229cfa8
Original Articles

Worry has been implicated in increasing the levels of distress associated with persecutory delusions. It may partly cause this distress via the impediment of emotional processing of upsetting experiences. The clinical implication is that enhancing emotional processing of paranoid experiences will reduce distress. We therefore piloted a new brief intervention-the Emotional Processing and Metacognitive Awareness (EPMA)-on 12 patients with persistent persecutory delusions. The intervention was predominately influenced by written emotional disclosure and lasted for three sessions. The delusions were assessed at baseline, preintervention and postintervention and during a one-month follow-up. It was found that EPMA particularly reduced levels of delusion distress, and this was maintained at follow-up. The effect sizes were large but were likely overestimated given the absence of a control group and assessments that were not blind. These preliminary findings suggest that simply encouraging patients to talk, in the right way, about their delusions can be beneficial.

*Department of Psychology, Institute of Psychiatry, King's College London, London; and †Department of Psychiatry, Oxford University, Oxford, UK.

This study was supported by a Medical Research Council (MRC) Senior Clinical Fellowship awarded to Daniel Freeman.

Send reprint requests to Daniel Freeman, PhD, Department of Psychiatry, Oxford University, Warneford Hospital, Oxford OX3 7JX, UK. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.