Developing treatments of persistent persecutory delusions: The impact of an emotional processing and metacognitive awareness intervention.

Worry has been implicated in increasing the levels of distress associated
with persecutory delusions. It may partly cause this distress via the
impediment of emotional processing of upsetting experiences. The clinical
implication is that enhancing emotional processing of paranoid experiences
will reduce distress. We therefore piloted a new brief intervention--the
Emotional Processing and Metacognitive Awareness (EPMA)--on 12 patients
with persistent persecutory delusions. The intervention was predominately
influenced by written emotional disclosure and lasted for three sessions. The
delusions were assessed at baseline, preintervention and postintervention and
during a one-month follow-up. It was found that EPMA particularly reduced
levels of delusion distress, and this was maintained at follow-up. The effect
sizes were large but were likely overestimated given the absence of a control
group and assessments that were not blind. These preliminary findings suggest
that simply encouraging patients to talk, in the right way, about their
delusions can be beneficial.