Freeman Daniel
Lancet Psychiatry. 2016 Jul;3(7):685-92. doi: 10.1016/S2215-0366(16)00066-3.
A spectrum of severity of paranoia (unfounded thoughts that others are deliberately intending to cause harm) exists within the general population. This is unsurprising: deciding whether to trust or mistrust is a vital aspect of human cognition, but accurate judgment of others' intentions is challenging. The severest form of paranoia is persecutory delusions, when the ideas are held with strong conviction. This paper presents a distillation of a cognitive approach that is being translated into treatment for this major psychiatric problem. Persecutory delusions are viewed as threat beliefs, developed in the context of genetic and environmental risk, and maintained by several psychological processes including excessive worry, low self-confidence, intolerance of anxious affect and other internal anomalous experiences, reasoning biases, and the use of safety-seeking strategies. The clinical implication is that safety has to be relearned, by entering feared situations after reduction of the influence of the maintenance factors. An exciting area of development will be a clinical intervention science of how best to enhance learning of safety to counteract paranoia.
偏执狂（毫无根据的认为他人故意造成伤害的想法）在普通人群中存在不同程度的严重情况。这并不奇怪：决定信任还是不信任是人类认知的一个重要方面，但准确判断他人意图具有挑战性。最严重的偏执狂形式是被害妄想，即这些想法被坚定地持有。本文介绍了一种正在转化为针对这一主要精神问题治疗方法的认知方法的提炼。被害妄想被视为在遗传和环境风险背景下形成的威胁信念，并通过包括过度担忧、缺乏自信、无法忍受焦虑情绪和其他内部异常体验、推理偏差以及使用寻求安全策略等多种心理过程得以维持。临床意义在于，在减少维持因素的影响后，通过进入恐惧情境来重新学习安全。一个令人兴奋的发展领域将是关于如何最好地加强安全学习以对抗偏执狂的临床干预科学。
