Department of Psychology, University of Sheffield, UK.
Department of Social and Organizational Psychology, University of Groningen, The Netherlands.
Psychol Psychother. 2021 Sep;94(3):391-406. doi: 10.1111/papt.12314. Epub 2020 Dec 13.
Paranoia is known to be associated with insecure attachment, with negative self-esteem as a mediator, but this pathway is insufficient to explain the paranoid individual's beliefs about malevolent others. Mistrust is a likely additional factor as it is a core feature of paranoid thinking also associated with insecure attachment styles. In this study, we tested whether mistrust - operationalized as judgements about the trustworthiness of unfamiliar faces - constitutes a second pathway from insecure attachment to paranoia.
The design of the study was cross-sectional.
A nationally representative British sample of 1,508 participants aged 18-86, 50.8% female, recruited through the survey company Qualtrics, completed measurements of attachment style, negative self-esteem, and paranoid beliefs. Usable data were obtained from 1,121 participants. Participants were asked to make trustworthiness judgements about computer-generated faces, and their outcomes were analysed by conducting signal detection analysis, which provided measures of bias (the tendency to assume untrustworthiness in conditions of uncertainty) and sensitivity (accuracy in distinguish between trustworthy and untrustworthy faces).
Results using structural equation modelling revealed a good model fit (RMSEA = .071, 95% CI: 0.067-0.075, SRMR = .045, CFI = .93, TLI = .92). We observed indirect effects through bias towards mistrust both for the relationship between attachment anxiety and avoidance (β = .003, 95% CI: 0.001-0.005,p < .001) and attachment anxiety and paranoia (β = .003, 95% CI 0.002-0.006, p < .001). We observed an indirect effect through negative self-esteem only for the relationship between attachment anxiety and paranoia (β = .064, 95% CI: 0.053-0.077, p < .001). Trust judgements and negative self-esteem were not associated with each other.
We find that a bias towards mistrust is associated with greater paranoia. We also find indirect effects through bias towards mistrust between attachment styles and paranoia. Finally, we reaffirm the strong indirect effect through negative self-esteem between attachment anxiety and paranoia. Limitations of the study are discussed.
When working with individuals suffering from paranoia, clinicians should consider not only explicit, deliberative cognitive processes of the kind addressed in cognitive behaviour therapy (e.g. cognitive restructuring) but also the way in which their patients make perceptual judgements (e.g., their immediate reactions on encountering new people) and consider interventions targeted at these judgements, for example, bias modification training. Assessment and clinical interventions for people should consider the role of trust judgements and the way in which they combine with low self-esteem to provoke paranoid beliefs. Psychological interventions targeting paranoid beliefs should focus on both attachment anxiety and attachment avoidance.
众所周知，偏执与不安全的依恋有关，而自卑则是其中的一个中介因素，但这条途径还不足以解释偏执个体对恶意他人的信念。不信任可能是另一个重要因素，因为它是偏执思维的核心特征之一，也与不安全的依恋风格有关。在这项研究中，我们测试了不信任——即对陌生面孔可信度的判断——是否构成从不安全依恋到偏执的第二条途径。
研究设计为横断面研究。
通过调查公司 Qualtrics，我们招募了 1508 名年龄在 18-86 岁之间的具有代表性的英国参与者（50.8%为女性），完成了依恋风格、自卑和偏执信念的测量。从 1121 名参与者中获得了可用数据。参与者被要求对计算机生成的面孔做出可信度判断，我们通过进行信号检测分析来分析他们的判断结果，该分析提供了偏差（在不确定条件下倾向于不信任的趋势）和敏感性（区分可信赖和不可信赖面孔的准确性）的测量指标。
使用结构方程模型的结果显示出良好的模型拟合度（RMSEA=0.071，95%置信区间：0.067-0.075，SRMR=0.045，CFI=0.93，TLI=0.92）。我们观察到，在依恋焦虑和回避（β=0.003，95%置信区间：0.001-0.005，p<0.001）以及依恋焦虑和偏执（β=0.003，95%置信区间：0.002-0.006，p<0.001）之间的关系中，通过对不信任的偏见存在间接影响。我们仅在依恋焦虑和偏执之间的关系中观察到通过自卑的间接影响（β=0.064，95%置信区间：0.053-0.077，p<0.001）。信任判断和自卑之间没有关联。
我们发现，对不信任的偏见与更大的偏执有关。我们还发现，在依恋风格和偏执之间存在通过对不信任的偏见的间接影响。最后，我们重申了依恋焦虑和偏执之间通过自卑的强烈间接影响。讨论了研究的局限性。
当与患有偏执的个体合作时，临床医生不仅应考虑认知行为疗法中涉及的明确、深思熟虑的认知过程（例如认知重构），还应考虑他们的患者进行感知判断的方式（例如，他们遇到新的人时的即时反应），并考虑针对这些判断的干预措施，例如偏见修正训练。针对个体的评估和临床干预应考虑信任判断的作用以及它们与低自尊相结合引发偏执信念的方式。针对偏执信念的心理干预应同时关注依恋焦虑和回避。
