Institute of Psychology, Illinois Institute of Technology, Chicago, IL 60616, USA.
Med Hypotheses. 2010 Dec;75(6):568-71. doi: 10.1016/j.mehy.2010.07.033. Epub 2010 Aug 14.
Persecutory ideation is one of the most commonly reported psychiatric symptoms in individuals with schizophrenia and is associated with significant patient distress and impairment. Therefore, much attention has recently been devoted to theoretical explanations of persecutory ideation that can help inform and guide patient care. A cognitive model of persecutory ideation suggests that individuals with psychosis who experience anxiety along with other stressors are at increased risk for developing intense "threat" or persecutory beliefs. Correlational studies have found evidence for this proposed link between anxiety levels and the persistence, distress levels, and degree of conviction associated with persecutory ideation. Importantly, recent research has found support for a possible prospective/causal role for anxiety in the generation and maintenance of paranoid beliefs. Existing interventions for persecutory ideation consist of pharmacological treatments that have variable efficacy and often entail serious side-effects, and cognitive behavioral treatments (CBT) that target persecutory thoughts, but are often unavailable, require high level of clinician expertise, and may be difficult to conduct with patients who are cognitively impaired or apprehensive about openly exploring their paranoid beliefs. Given the empirical support for a prospective relationship between anxiety and persecutory ideation, it is reasonable to predict that clinicians could impact persecutory ideations indirectly by making good use of existing evidence-based interventions for anxiety. Progressive Muscle Relaxation (PMR) is an effective method for reducing physiological arousal and treating various anxiety disorders, and has been shown to be feasible with patients with psychosis. We offer that exportability and ease of use makes PMR a promising intervention for mental health practitioners to target anxiety precipitating persecutory ideation. We hypothesize that PMR could be used to help ameliorate anxiety in patients who are at risk or already experiencing persecutory ideation, subsequently reducing the frequency, level of conviction, and distress associated with persecutory thoughts. Our hypothesis could be tested through feasibility and randomized control trials of PMR for treatment of persecutory ideation in individuals with schizophrenia. We expect the relationship between PMR and persecutory ideation will be mediated by reduction in anxiety. Potential advantages of examining our hypothesis include identifying a viable, efficacious, cost-effective novel intervention for paranoia in patients with psychosis. In addition, PMR could be easily facilitated by practitioners with varying levels of training and integrated with other existing interventions for persecutory ideation.
被害妄想是精神分裂症患者最常报告的精神症状之一，与患者的严重痛苦和障碍有关。因此，最近人们非常关注可以帮助提供信息和指导患者护理的被害妄想的理论解释。被害妄想的认知模型表明，患有精神病的个体在经历焦虑和其他压力源时，患强烈的“威胁”或被害信念的风险增加。相关研究为焦虑水平与被害妄想的持续时间、困扰程度和坚信程度之间的这种拟议联系提供了证据。重要的是，最近的研究为焦虑在妄想信念的产生和维持中的可能前瞻性/因果作用提供了支持。现有的被害妄想干预措施包括疗效各异且常伴有严重副作用的药物治疗，以及针对被害性思维的认知行为治疗（CBT），但往往无法获得，需要高水平的临床医生专业知识，并且可能难以对认知受损或不愿公开探讨其被害性信念的患者进行。鉴于焦虑与被害妄想之间存在前瞻性关系的实证支持，合理的预测是，临床医生可以通过充分利用现有的焦虑症循证干预措施，间接地影响被害妄想。渐进性肌肉松弛（PMR）是一种减少生理唤醒和治疗各种焦虑症的有效方法，并且已被证明对精神病患者可行。我们认为，PMR 的可推广性和易用性使其成为心理健康从业者针对引发被害妄想的焦虑的有前途的干预措施。我们假设，PMR 可用于帮助减轻有被害妄想风险或已经出现被害妄想的患者的焦虑，从而降低与被害性思维相关的频率、坚信程度和困扰。我们可以通过 PMR 治疗精神分裂症个体被害妄想的可行性和随机对照试验来检验我们的假设。我们预计 PMR 与被害妄想之间的关系将通过焦虑的减轻来介导。检验我们假设的潜在优势包括为精神病患者的妄想症确定一种可行、有效、具有成本效益的新干预措施。此外，PMR 可以由具有不同培训水平的从业者轻松实施，并与其他现有的被害妄想干预措施相结合。
