Iyassu Robel, Jolley Suzanne, Bebbington Paul, Dunn Graham, Emsley Richard, Freeman Daniel, Fowler David, Hardy Amy, Waller Helen, Kuipers Elizabeth, Garety Philippa
PO77 Department of Psychology, King's College London, Institute of Psychiatry, University of London, Denmark Hill, London, SE5 8AF, UK.
Soc Psychiatry Psychiatr Epidemiol. 2014 Jul;49(7):1051-61. doi: 10.1007/s00127-013-0811-y. Epub 2013 Dec 31.
Religious delusions are common and are considered to be particularly difficult to treat. In this study we investigated what psychological processes may underlie the reported treatment resistance. In particular, we focused on the perceptual, cognitive, affective and behavioural mechanisms held to maintain delusions in cognitive models of psychosis, as these form the key treatment targets in cognitive behavioural therapy. We compared religious delusions to delusions with other content.
Comprehensive measures of symptoms and psychological processes were completed by 383 adult participants with delusions and a schizophrenia spectrum diagnosis, drawn from two large studies of cognitive behavioural therapy for psychosis.
Binary logistic regression showed that religious delusions were associated with higher levels of grandiosity (OR 7.5; 95 % CI 3.9-14.1), passivity experiences, having internal evidence for their delusion (anomalous experiences or mood states), and being willing to consider alternatives to their delusion (95 % CI for ORs 1.1-8.6). Levels of negative symptoms were lower. No differences were found in delusional conviction, insight or attitudes towards treatment.
Levels of positive symptoms, particularly anomalous experiences and grandiosity, were high, and may contribute to symptom persistence. However, contrary to previous reports, we found no evidence that people with religious delusions would be less likely to engage in any form of help. Higher levels of flexibility may make them particularly amenable to cognitive behavioural approaches, but particular care should be taken to preserve self-esteem and valued aspects of beliefs and experiences.
宗教妄想很常见，且被认为特别难以治疗。在本研究中，我们调查了导致所报道的治疗抵抗背后可能存在的心理过程。我们尤其关注在精神病认知模型中被认为维持妄想的感知、认知、情感和行为机制，因为这些构成了认知行为疗法的关键治疗靶点。我们将宗教妄想与具有其他内容的妄想进行了比较。
383名患有妄想且被诊断为精神分裂症谱系障碍的成年参与者完成了症状和心理过程的综合测量，这些参与者来自两项针对精神病的认知行为疗法的大型研究。
二元逻辑回归显示，宗教妄想与较高水平的夸大观念（比值比7.5；95%置信区间3.9 - 14.1）、被动体验、有支持其妄想的内部证据（异常体验或情绪状态）以及愿意考虑其妄想的替代观点（比值比的95%置信区间为1.1 - 8.6）相关。阴性症状水平较低。在妄想信念、洞察力或对治疗的态度方面未发现差异。
阳性症状水平，尤其是异常体验和夸大观念较高，可能导致症状持续存在。然而，与先前的报道相反，我们没有发现证据表明患有宗教妄想的人接受任何形式帮助的可能性更低。更高的灵活性可能使他们特别适合认知行为疗法，但应特别注意维护自尊以及信念和体验中有价值的方面。
