一个理解和治疗受迫害妄想的平衡模型。

IF 5.5 2区 医学 Q1 PSYCHIATRY
Daniel Freeman, Louise Isham, Felicity Waite
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引用次数: 0

摘要

直接的挑战很少能改变人们根深蒂固的信念,比如受迫害妄想。更好的方法是发展一种可以与妄想共存的替代信念。最好的信念可以抵消错觉。随着时间的推移,天平发生了变化。另一种信念变得比错觉更强大。在本文中,我们提出了这样一个受迫害妄想(或严重偏执)的模型,并描述了它是如何将理论理解转化为治疗路线的。当决定是否信任的适应性认知过程过度偏重于不信任时,就会出现严重的偏执。一种不准确的威胁信念形成了,这个人感到非常不安全。因此,克服妄想意味着发展一种与之抗衡的信念。这意味着建立另一种观点,即世界对现在和未来的人来说是足够安全的。反过来,这是通过体验安全来实现的。然而,由于过去的历史、焦虑的唤醒、幻觉、脆弱的感觉、防御的使用、退缩、担心、难以摆脱恐惧和挫败感等多种因素,偏执的吸引力很强。这些因素甚至会使人在最温和的环境中感到不安全。因此,必须为这些因素制定平衡。例如,感觉脆弱可以通过培养自信来抵消。花在担心上的过多时间可以通过花更多时间思考有意义的活动来抵消。平衡方法提供了一种非对抗性的、共情的、个性化的方式来减轻患有受迫害妄想的患者的偏执负担。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A counterweight model for understanding and treating persecutory delusions.

Direct challenge seldom leads to change in strongly held beliefs such as persecutory delusions. A better route is to develop an alternative belief that can coexist with the delusion. The best such beliefs function as counterweights to the delusion. Over time, the scales shift. The alternative belief becomes more powerful than the delusion. In this paper, we set out such a model of persecutory delusions (or severe paranoia) and describe how it inherently translates theoretical understanding into treatment routes. Severe paranoia occurs when the adaptive cognitive processes of deciding whether to trust become overly weighted to mistrust. An inaccurate threat belief is formed, and the person feels very unsafe. Hence, overcoming the delusion means developing a counterweighting belief. It means building the alternative view that the world is safe enough for the person now and going forward. This, in turn, is done by experiencing safety. However, the pull of paranoia is strong due to multiple factors such as past history, anxious arousal, hallucinations, feelings of vulnerability, use of defenses, withdrawal, worry, difficulties distancing from fears, and a sense of defeat. These factors can prevent the person from feeling safe in even the most benign environments. Therefore, counterweights must be developed for these factors. For instance, feeling vulnerable can be counterweighted by developing self-confidence. Excessive time spent worrying can be counterweighted by devoting more time to thinking about meaningful activities. The counterweight approach provides a non-confrontational, empathic, personalized way to lift the burden of paranoia from a patient with persecutory delusions.

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来源期刊
Psychological Medicine
Psychological Medicine 医学-精神病学
CiteScore
11.30
自引率
4.30%
发文量
711
审稿时长
3-6 weeks
期刊介绍: Now in its fifth decade of publication, Psychological Medicine is a leading international journal in the fields of psychiatry, related aspects of psychology and basic sciences. From 2014, there are 16 issues a year, each featuring original articles reporting key research being undertaken worldwide, together with shorter editorials by distinguished scholars and an important book review section. The journal''s success is clearly demonstrated by a consistently high impact factor.
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