Presents
Peter BullimoreDay 1
9.00am – 12.30pm
Workshop 1
Working with Paranoia & Unusual Beliefs
History of paranoia
The word paranoia was coined by Hippocrates who is commonly described as the founder of Medicine who was born around the year 460BC on the Greek island of Kos.
He used the word paranoia to describe people’s experiences when they had a very high temperature.
He did this by putting together the Greek words (Para) beside and (Nous) mind, to create a word ‘out of ones mind’.
How many CCTV cameras are there in England?
5 million 20% of the worlds population
Who is more likely to suffer from paranoia?
• Paranoia tends to be more common in towns and cities than rural areas, its incidence is very difficult to judge, however, as some forms of paranoia can occur in over 80 medical conditions. For example people may become paranoid as a result of ageing or depression – feeling that they have become a burden – or even through partial deafness – which can cause people to think that their friends and relatives are whispering to conceal something from them. As many as 32% of old people in geriatric wards are diagnosed with some form of paranoia.
The effects of drugs
• As well as the effects of illnesses such as dementia, paranoia can have physical/chemical origins. Drugs such as LSD and amphetamines all have the capacity to induce paranoid states. Some steroids taken by weightlifters and athletes, fuels, insecticides and paint have been associated with paranoid states, but these can be episodic, but you can be diagnosed with schizophrenia during one of the episodes
1.What does paranoia mean to you?
2.How could you recognise when someone is paranoid?
Fear Potential Inventory• Things that regularly frighten me are :-
..............................................................................................................
• I get frightened when I think about / remember :-..................................................................................................................
• The things that I am most stressed about are :-.......................................................................................................................
• I might get frightened if I go to :- ........................................................................................................................
• What do you think people should not do to others?........................................................................................................................
Consequences
Which of these is the starting point? (triggers).
We need to deal with stress, anger, people, life experience and situations.
Think about these experiences as fear free
What is paranoia without fear?
What are voices without fear?
What is anxiety without fear?
Can you have a panic attack without fear?
Is the master emotion
Traditional assumptions about paranoia and paranoid delusions
•An irrational and false belief•Belonging to an individual (or, more rarely, a couple or group)
•A sign of pathology •The content and context of which are meaningless
Aims of intervention•To reduce distress by eliminating the belief in some way (e.g. through the
•use of psychiatric medication)•To make the person more ‘rational’
Problems with traditional assumptions
•They are based on a naively realist view of the world, but….-Most people are diagnosed without empirical investigations taking place
•Agreement between diagnoses are poor •We do not have ‘objective’ evidence for many beliefs
• (e.g. political, ethical, religious etc.)Conventional theories see ‘delusions’ as abnormal in some way but ….
•Surveys of general public show high rates of belief in supposedly •irrational phenomena
A Gallup survey (1995) found the following rates of belief:
Telepathy 45%Ability to predict the future 45%
Hypnotism 42%Life after death 39%
Faith healing 39%Ghosts 31%
Alien abduction 70%U.F.O‘s 35%
•Studies find it hard to differentiate between ‘normal’ and ‘deluded’ people•There is evidence that people vary in their conviction in supposedly delusional beliefs
Delusions are seen as meaningless but….•There is evidence that ‘delusional beliefs’ may relate to purpose
and meaning in life•Links may be found between themes in a person’s ‘delusions’
and in their life•Surveys report a link between paranoid beliefs and social positions characterised by powerlessness and the threat of
victimisation and exploitation
THOUGHTS FEELINGS
BEHAVIOUR
Making sense of paranoia
THOUGHTSTRIGGER
BEHAVIOURCONVICTION
FEELINGS(Threat)
CONSPIRACY
Trigger / Thoughts They have just looked at me in a strange way
are they sniggering at me?
Conspiracy/ Feelings I don’t feel safe in this situation I am getting
very anxious I want to get away they are definitely plotting something.
Conviction / Behaviour I am going to hide away I don’t feel safe
around people Which of the above is the main problem?
Conviction
Conspiracy
Trigger
Story(What's happening now)
History( How have you got here what
brought you to services)
Past/Present( determine the relationship
between past events and present experiences)
Angie, 38 years old
Angie and her sister were brought up by their mother who was a heroin addict. At times when their mother wasn’t able to inject herself Angie would have to do it for
her. When she was 7 years old her mother died of a heroin overdose. Angie was never sure whether she had administered the fatal dose. Their grandfather gained custody of them and began to abuse them. As he abused her sister he would make Angie hit
her at the same time. He would tell her he was a hypnotist and he would put a ‘bar’ in her head so she wouldn’t remember the abuse. After each incident of abuse he would
urinate upon her. As she approached 14 years of age her behaviour became very aggressive and she was placed in a school for dysfunctional children. Whilst in there she was given large doses of anti psychotic medication which she continued to take
for many years. When she was 21 years old she got into an abusive relationship where her boyfriend would play mind games with her and frighten her. When the
relationship broke up he told her she would never be free of him. For many years she became increasingly frightened and paranoid and was admitted to psychiatric services at the age of 26 where she received a diagnosis of schizo-affective disorder. She had
long spells in hospital. Whenever she tried to talk about her experiences she was disbelieved and was told it was part of her illness.
At the age of 33 she went cold turkey off all her medication and handed herself into the police telling them that she had been abusing children. She became convinced that a man would enter her flat every Friday. She was not allowed to see his face. He would
change around cameras that he had installed to monitor her with, strip her naked, have sex with her and spray shaving foam inside her. He would then urinate on the carpet.
She became very fearful of police and psychiatric services, refusing to engage with them as they were part of the conspiracy. The police took no action over the child abuse
charges.
TriggerWhy was she convinced she was an abuser?What could you do when she says she can smell urine?
Conspiracy
She feels frightened and powerless. What action would you take at this point?
Conviction
She is convinced this man enters her flat every Friday. How could you help her make sense of this belief?
Feedback
A trigger point One of her triggers is that she says that she can smell urine. Ask her what has been happening in the last few weeks, take action, seek support and advice if necessary, try and make her see the relationship between past events.
Conspiracy
Prepare for this stage by asking her to identify people she can trust in a crisis, check out the reality of her fears and feelings, ask her why she has not already been arrested if she is a child abuser, try to raise an element of doubt to her belief system
Conviction
Arrange meetings away from her flat on Friday, ask her why he didn’t come on another day, ask her why she wasn’t allowed to see his face.
Question; What role did the ‘bar’ play that her grandfather said he put in her head? What did it symbolise? What could the shaving foam be?
Alarm systems
Alarm systems are related to circumstances that become the trigger. For example smelling urine. Irrational thoughts are what we first react to, but the thoughts are rational when
the initial threat occurred.Trauma goes away, but thoughts and memory remain. Fearful situations stay in the brain
and are easily activated.
Negative response
People saying your thoughts are not real.
Positive response
When were your thoughts and beliefs more real? When did they start?
The relationship is more important than the therapy.
Vicious circle
Threat
Thou
ghts
Feelings
Behaviour
Help break the cycleIncreased arousal/ hypervigilence
Emotional overload
Social withdrawal acts as retreat & protection
Conviction stage a
protective response
Response
Excessive Pressure
Perceived As lazy
Social withdrawal Retreat & protection
Clear supportive, positiveCommunication
Help try and make sense of Ideas and beliefs
Break cycle of threat
Help break
Paranoia what is a starting point for me?PARANOIA
VOICES SELF DOUBT INSECURITIES
HOW PARANOIA MAKES US FEELPeople are talking about me
Frightened Isolated/alone
GuiltyFeelings of grandeur
I take things personallyAnxious Betrayed
Exposed/ Take these thoughts awayInsecure
VulnerableHOW PARANOIA AFFECTS OUR BEHAVIOUR
Avoiding places/situationsWant to be safe
Withdraw
Triggers Warning signs
Increased ResponsibilityToo much pressure
Lack of sleepFear of failure
AlcoholInability to say “NO”
StrangersPhobias
People in authority People shouting
CoincidencesPublic transport
Certain days or evenings
Racing thoughtsSeeing things
Increase in voices or their negativity
Not making time to eatAltered sleep patternIncreasing isolation
Drinking more alcohol Taking more drugs legal/ illegal
Spending more time around others
WHAT HELPS WHAT DOESN’T HELP
Distraction/ Elastic bandIsolation short termReducing isolationWatching comedies
Listening to the radioBeing on a ward
-feeling safe-not having to pretend
Being listened to not judgedPeople valuing my experiencesTalking to others with the same
experience
IsolationGoing around alone/Fear of
attacks-Having a diagnosisBeing Humiliated
Being exposed as a ‘nutter’Media
-stereotypes-reading more into stories
Being on a ward/ cell-feeling powerless
-being made to feel a nuisanceMedication-side effects
Not being believed experiences denied
Managing paranoia
Medication (Use wisely)Talking therapy (why am I thinking this way)
Accept it is part of the human conditionIt’s OK to have a bad dayAcknowledge progress Exercise/ Endorphins
Practice positive thinking/ not negative/Look at moodRationalise thoughts and ideas/why are people talking about me?
Share my fears with trusted personKeep busy
Reflect on past experiences (what happened)Guard against seduction of madness
Reinforce positives/ reflect on achievements-I got through another day
Use your intelligence to understand itWork with people you trust
Create safety
Managing paranoia
Medication (Use wisely)Talking therapy (why am I thinking this way)
Accept it is part of the human conditionAcknowledge its existenceIt’s OK to have a bad dayAcknowledge progress
ExercisePractice positive thinking
Rationalise thoughts and ideasKeep busy
Reflect on past experiences (what happened)Take responsibilityReinforce positives
Use your intelligence to understand itWork with people you trust
Create safety
Additional Benefits
• Easy, simple practical ways of copingWorking within a person’s own reality is
straightforward and can be used by anyone, special training is not required. The strategies are simple to use and successfully used by nurses, occupational therapists, psychologists, relatives of people with unusual beliefs, as well as those using them as self-help.
• More positive identity & does not cause further distress
Attempting to change someone’s unshared or unusual beliefs can result in emotional distress arising from the experience of not being believed. Imagine you were being discriminated against because of your race or gender and when you complained it no-one believed you, but instead told you that you were misinterpreting things. It is likely that you would feel a range of unpleasant emotions such as depression, feelings of being judged or anger. Belief modification techniques, attempts to suggest or convince people that their unusual beliefs are wrong this can cause these same feelings and so result in alienating the person with unusual beliefs.
Belief systems Q1- What does this person want or need?
I want a drink.Q2- What is stopping them from getting what they need
I cannot because voices tell me water in my area has been poisoned and only I realise this.
Q3- What is the ultimate aim of the thing they cannot do?The ultimate aim is to get them a drink – not necessarily from the
local area.Q4- What things can the person do to get around the belief and
achieve the ultimate aim?They can drink by only using bottled water from other areas or
abroad.
Example Two Positive BeliefQ1- What does this person want or need?
This person needs to eat.Q2- What is stopping them from getting what they need?
He says “I don’t need to eat because I am invincible”.Q3- What is the ultimate aim of the thing they cannot do?
Ultimate aim is to get him to eat.Q4- What things can the person do to get around the belief
and achieve the ultimate aim?Encourage them to realise that even if they are invincible
there is no harm in eating anyway; at least it will stop everyone else worrying. Alternatively the person could be
encouraged to eat out or eat things they would prefer to eat.
Protection strategies John was convinced that people would attack him with knives so he
became very isolated refusing to leave the house.1 How would you get him out of the house?
2 How would you make him feel safe when leaving the house?How protection strategies helped John
I was living in a nightmare world at first, I had no way of dealing with the situation I acted “normally” but my inner world was filled
with terror words I cannot describe. I then started using (Protection Strategies) and my distress reduced considerably and I
felt much more able to cope, yet because I was acting oddly the professionals said I was getting worse.
If I didn’t use protection strategies my health would deteriorate at an astronomical rate I would start having blackouts and be
paralysed with fear.
John (Solutions)1.Arrange to go with John when leaving the house but plan the route first work out where there will be only a few people about.
2. Get him to wear a stab proof vest and carry a attack alarm.
Protection Strategies
A woman would experience visions of snakes coming to attack her. She prepared for this knowing that when the snakes came she should describe their size and location to her partner who would then pull them off her.
Jane felt that she would make people ill if she touched them, she refused to go shopping as she felt if she touched the shopkeeper whilst purchasing goods she would contaminate them. How could you get around this belief to enable Jane to go shopping?
When Jane goes out, make sure she takes lots of change so she can put the money on the counter so she doesn’t have to touch the shopkeeper.
Turning the situation around
Tom stated that he was being watched; he had tested it out and observed on a number of occasions that CCTV cameras would move to follow him, but not to follow his friends. At first he was uncomfortable and annoyed by this situation, but later accepted it and came to the conclusion that as he had done nothing wrong perhaps he was being watched for his own protection and should anyone try to harm him the authorities would have the evidence of the attacker on film.
Hats
Dora could feel her thoughts being broadcasted
so she would wear a hat and it would stop
them being broadcasted.
Steve could feel satellites bouncing off his head
so he would wear a cap with silver foil inside
and this would stop them.
Peter would say fridges and freezers would speak
to him so he would unplug them to take their power away and feel more in control. Peter also said sometimes the rubbish bin
would speak to him so he would remove the bin
liner to prove he had power over it.
DECODINGSometimes people tell us about their experiences and they are
viewed as bizarre but if we decode them they have a meaning often related to their emotions below are some examples of what people
often say and how we can decode them.•I am an alien
•They are saying I feel like an alien I don’t fit in society•I am being poisoned
•I don’t feel like I can trust people right now medication is making me feel sick
•I am a prophet•I have to be a prophet or I am just a crazy person
•Someone is watching me•Why am I being observed on the ward•There is a secret army out to get me
•People/ family keeping secrets about your problems
How Beliefs are Maintained
• Avoidance• Lack of knowledge about anxiety or social
skills (i.e. no reality testing)• Unsuccessful strategies that reinforce beliefs• Lack of communication
Intervention
• Form therapeutic alliance • Non confrontational Remember protective function beliefs may
serve & help with self esteem
Informational Questions
• How did you cope?• What did you do?• When was the last time you noticed
yourself being monitored?• What did it feel like?
Exploratory Questions
• Could anything bad happen to you if you were monitored?
• Have you heard this happening to anyone else?
• What would it mean if …..Happened?• How small would a camera need to be?• What led the police to be interested in you?• How much would this surveillance cost?
Forming a relationship and providing safety
• Don’t use the word delusion as it implies immediate dismissal of their ideas. It implies “you’re mad and don’t know what you are talking about”.
• Don’t confront. Take their word at face value, recognise that their experiences are real for them without confirming what they believe. Try to empathise with the emotions created by their experiences. If people are confronted it tends to lead to further entrenchment of beliefs.
• Don’t collude. Be honest, people can detect patronising attitudes.
• Be reliable and honest.
• If disagreeing, do so with tact and sensitivity.• Good interpersonal skills are essential.• Be prepared to tactically withdraw.• Use appropriate personal disclosure.
Providing safety might also be about providing an environment in which the person feels safe.
Little witch
Body state info
Diabetes Lesions in eyes
Sex machine IBS
Thought insertion
Ego/Dystonic intrusions thoughts outside the personality
Possessed
Peripheral neuropathy glue and alcohol abuse desensitises feelings in hands etc
The Devil
Respiratory alchosis loss of breath, Taking in to much oxygen without breathing out also known as lobstering (limbs stiffen)
Quiet common for people to feel paralysed and see something or someone coming towards them.
A sign that people are really stressed Prosopagnosia/Face Blindness
The Power of Communication
No one had paid George any attention for years. Now doctors, attendants and nurses all talked to him and watched eagerly to see what effect the drug would have.
His condition improved rapidly. After only two weeks of the drug treatment he was moved to a ward for less disturbed patients where he took part in a number of
activities. Soon he was doing so well he was promoted again. By this time he had lively relationships with other patients and many members of staff. He began to spend
several hours a day with paints and clay, using them to express the rich fantasy life that had previously interested no one. His doctors marveled. Attendants praised his skill. George was released from hospital thirty-eight days after his first dose of Thorazine.
Whilst he was signing out he remembered that he left something behind, went back to his room returned with and old sock. The puzzled attendant who asked to see it
found thirty-eight Thorazine pills carefully, stashed inside the sock.
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