Self-Structure in Persecutory Delusions

There is currently limited research examining self-structure in clinical groups and no current data on the extent to which self-structure is amendable to change following psy-chological therapy. We address this important gap by examining self-structure in individuals with persecutory delusions using the card sort task, an established paradigm measuring key self-structure indices, including the degree to which self-structure is compartmentalized (characterized by primarily positive or negative attributes, as opposed to a mix of both), and the proportion and importance of nega-tive attributes. In Study 1, individuals with a schizophrenia spectrum diag-nosis with current persecutory delusions (clinical group, n = 27) and a healthy control group (n = 47) were com-pared on self-structure indices. In Study 2 (n = 27), the clin-ical group also completed the card sort task before and after randomization to either a 12-week mindfulness -based psychological therapy or treatment-as-usual control. In Study 1, self-structure differed significantly between the clinical and control groups. The clinical group had a greater proportion of negative attributes, assigned more importance to negative self-aspects, and had more com-partmentalized self-structures compared with controls. In Study 2 there were no associations between delusion sever-ity and self-structure. Large effect sizes for reductions in compartmentalization and proportion of negative attri-butes across self-aspects were found following mindfulness therapy. The findings highlight key differences in self -structure between individuals with persecutory delusions and healthy controls, and suggest that it might be possible to change self-structure following psychological therapy. These data support the central role of the self in theoretical models of paranoid thinking.