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Title: Distinguishing social anxiety from paranoia : testing the aetiological role
Author: Huo, Yuanyuan
ISNI:       0000 0004 7963 9236
Awarding Body: King's College London
Current Institution: King's College London (University of London)
Date of Award: 2019
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This thesis investigates the relationship between interpretation biases, social anxiety and paranoia. The overarching hypothesis is that differences in the manner of interpretation of emotionally ambiguous information may determine the type of symptoms which predominate, perhaps even which pathology emerges. For example, an interpretation which assumes an intent of harm (e.g. seeing two people whispering while looking at you means 'they are plotting against me') is likely to precipitate negative paranoid thoughts, perhaps ultimately persecutory delusions. In contrast, an interpretation of the same ambiguity, but which assumes the self is being negatively evaluated by others (e.g. seeing two people whispering while looking at you means 'they are talking about my faults') is likely to precipitate socially anxious thoughts and perhaps ultimately social anxiety disorder. Experiment 1 (n=84) examined the form and strength of the associations between the hypothesised different types of interpretation bias (socially anxious resolutions/paranoid resolutions) and the traits of social anxiety versus paranoia. The results showed that there was a significant association between different types of interpretation bias and its content specific emotion trait. The negatively evaluated (socially anxious resolutions) interpretation bias was more strongly associated with social anxiety than the persecutory (paranoid resolutions) interpretation bias. Conversely, the persecutory (paranoid resolutions) interpretation bias was more strongly associated with paranoia than the negatively evaluated (socially anxious resolutions) interpretation bias. Experiment 2 (n= 80) extended Experiment 1 by altering the task design to directly contrast paranoid and socially anxious interpretations (rather than contrasting paranoid versus non paranoid and, separately, socially anxious versus non-socially anxious). Under this forced-choice experimental design, the results revealed that there was a significant association between persecutory interpretation and its content specific emotion (paranoia). However, both types (negatively evaluated and persecutory) of interpretation bias were significantly associated with social anxiety. Experiment 3 (n = 71) was a longitudinal follow up study (for which Experiment 1 served as the baseline). This study tested whether content specific interpretation biases would predict corresponding traits six months later, as an indirect test of the causal role of interpretation biases in precipitating social anxiety and paranoia. The results showed that negatively evaluated interpretation bias predicted subsequent social anxiety traits, and likewise persecutory interpretations predicted subsequent paranoia traits. Moreover, there was an interaction effect between the two types of bias suggesting that the predictive power of paranoid interpretation bias was especially strong when coexisting with a strong socially negative interpretation bias, which lends support to some theories of clinical paranoia. Experiment 4 used a combination of existing and new data collected over a six-month period to test the hypothesis of reciprocal causality (do traits contribute to the exacerbation of congruent biases in addition to biases maintaining traits, such that a vicious cycle is established?). The data showed a reciprocal causality of the trait social anxiety in corresponding negatively evaluative interpretation bias, while there was an absent contribution of the trait paranoia to persecutory interpretation bias, which was instead due to the trait social anxiety. Experiment 5 recruited a large clinical sample plus healthy controls (n= 102) to examine similar questions to those tested in the previous subclinical samples. The results revealed a 3 pattern broadly consistent with the content specific interpretation biases in both social anxiety and paranoid psychosis patients. Findings of this thesis confirm the cognitive theories of psychopathology in social anxiety and early psychosis. The study demonstrates a reciprocal causality between social anxiety and both persecutory and negatively evaluated interpretation bias. It has confirmed the vicious circle proposed by cognitive theories of social anxiety, and suggested a mechanism for the maintenance of persecutory interpretation bias in paranoia. Although content-specific interpretation bias was weighted the most in the prediction of its corresponding trait characteristics, the effects from the content-unmatched interpretation bias could not be neglected. This finding extends previous observations using similar methods in subclinical samples, and suggests an aetiological pattern that goes beyond the notion of content specificity.
Supervisor: Yiend, Jenny Hazel ; Shergill, Sukhwinder S. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available