Can Virtual Reality Be Used to Understand Persecutory
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CAN VIRTUAL REALITY BE USED TO UNDERSTAND PERSECUTORY DELUSIONS? Miriam Fornells-Ambrojo D. Clin. Psy. Thesis (Volume 1), 2007 University College London UMI Number: U591988 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. Dissertation Publishing UMI U591988 Published by ProQuest LLC 2013. Copyright in the Dissertation held by the Author. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 O v e r v ie w This thesis focuses on understanding persecutory delusions from an interpersonal perspective. It is divided into three parts. Part I provides a critical review of the literature on interpersonal processes in paranoia by discussing theoretical approaches and the empirical evidence. The evidence is reviewed in five areas: interpersonal life events, attachment, relational schemas, social cognition and interpersonal behaviour. Part II describes an empirical investigation on persecutory delusions under controlled laboratory conditions. Virtual reality (VR) has previously been used to study paranoid ideation in non-clinical individuals and in individuals at high risk of psychosis. The current study is the first to investigate the applicability of the method to people with current persecutory delusions. Its main aims were to assess the acceptability and safety of using VR with individuals with persecutory delusions and to determine whether they experienced paranoid thoughts in VR. Lastly, part III is a critical appraisal of the research process. The challenges and opportunities of using a novel technology with a clinical population who has severe psychopathology are discussed. The thesis ends with a reflection on how my understanding of paranoia has evolved as a result of conducting this work. 2 T a b l e o f c o n t e n t s Can virtual reality be used to understand persecutory delusions? ..................................1 O verview.................................................................................................................................2 Table of contents ..................................................................................................................3 Tables and figures..................................................................................................................6 Acknowledgements ................................................................................................................ 7 Part 1: Literature review .......................................................................................................... 9 The role of interpersonal processes in paranoia: a critical review of theory and evidence .......................................................................................................................................9 Abstract .................................................................................................................................. 10 Introduction .......................................................................................................................... 11 Theoretical review: Interpersonal processes in current cognitive models of persecutory delusions ..........................................................................................................14 The social environment and psychosis ........................................................................14 Attributions-self-representation cycle (ASRC) model of persecutory delusions 18 The threat anticipation model of persecutory delusions ....................................... 19 An interpersonal theory of the self: poor me and bad me paranoia ................... 21 Evidence on interpersonal processes inparanoia ..........................................................22 Live events....................................................................................................................... 23 Attachment ....................................................................................................................... 26 Beliefs about relatedness, self and others .............................................................. 29 Social cognition and reasoning biases ....................................................................... 40 Interpersonal behaviour ................................................................................................42 Summary and conclusions ................................................................................................. 45 Five questions on interpersonal process in paranoia: summary of the evidence .......................................................................................................................................................... 45 3 Methodological issues .................................................................................................... 48 Conclusions: further research and clinical implications ....................................... 50 References ............................................................................................................................53 Part 2: Empirical paper ...........................................................................................................67 Can virtual reality be used to understand persecutory delusions? ..............................67 Abstract ..................................................................................................................................68 Introduction ..........................................................................................................................69 Virtual reality in the study of paranoia: rationale ..................................................70 Persecutory ideation in virtual reality: findings from the paranoia continuum ............................................................................................................................................ 73 VR research on people with persecutory delusions: the current study .............74 Hypotheses ....................................................................................................................... 76 Method ................................................................................................................................... 77 Participants ......................................................................................................................77 Design and procedure .....................................................................................................78 Measures and m aterials ................................................................................................ 79 Data analysis....................................................................................................................86 Results ................................................................................................................................... 88 Demographic data ...........................................................................................................88 Persecutory delusion group: symptom description ................................................ 89 Factors associated with persecutory delusions ...................................................... 91 Is it feasible to use virtual reality with people with persecutory delusions?. 93 Persecutory ideation in VR: group differences ........................................................97 Factors associated with VR persecution .................................................................. 98 Persecutory ideation in VR: Thematic analyses .................................................... 100 Discussion .............................................................................................................................104 Negative schemas and reasoning biases in persecutory delusions ...................105 4 Paranoid thoughts in VR: a similar experience for both groups? ......................107 Are non-clinical participants too paranoid in VR? ................................................108 People with persecutory delusions: No biases in appraising a neutral VE? ..110 Implications ................................................................................................................... 113 References ..........................................................................................................................114 Part 3: Critical Appraisal ......................................................................................................124 The joys and perils of working with a new technology ........................................... 125 Using a new technology with people with persecutory delusions: concerns. 126 Designing a virtual environment to investigate paranoia................................... 130 My understanding of paranoia after the virtual reality project: .......................... 131 more questions than answers..........................................................................................131 References ..........................................................................................................................134