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Depression, goals and motivations in people with persecutory delusions
Author’s Accepted Manuscript Depression, goals and motivations in people with persecutory delusions Natasha Vorontsova, Lyn Ellett
www.elsevier.com/locate/psychres
PII: DOI: Reference:
S0165-1781(16)31105-2 http://dx.doi.org/10.1016/j.psychres.2017.04.041 PSY10467
To appear in: Psychiatry Research Received date: 29 June 2016 Revised date: 20 April 2017 Accepted date: 21 April 2017 Cite this article as: Natasha Vorontsova and Lyn Ellett, Depression, goals and motivations in people with persecutory delusions, Psychiatry Research, http://dx.doi.org/10.1016/j.psychres.2017.04.041 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
1
Depression, goals and motivations in people with persecutory delusions Dr Natasha Vorontsova and Dr Lyn Ellett*. Royal Holloway, University of London, London, UK. *
Corresponding author: Dr Lyn Ellett, telephone: +44 1784 414049, [email protected]. Abstract Goals motivated by avoidance, rather than approach, and by external, rather than
internal, motivations, have been implicated in the persistence of depression. This paper reports the first empirical investigation of the goals and motivations of individuals experiencing persecutory delusions. Participants completed assessments of goals and motivations, depression and paranoia. Higher levels of depression were associated with more avoidant motivations and lower goal self-concordance, but not with numbers of approach motivations. More avoidant motivations were also associated with greater paranoia. The findings are consistent with proposals that avoidant and externally-motivated goal pursuit could contribute to symptom persistence.
Keywords: Delusions, Goals, Motivations
1. Introduction Persecutory delusions are thought to be maintained by some of the same processes that perpetuate depression (Freeman and Garety, 2014). A growing area of research concerns motivations, which drive goal-directed behaviour. Studies of depressed and non-clinical groups have indicated that depression is associated with more avoidant motivations (e.g. “to not get into debt”), relative to approach motivations (e.g. “to meet like-minded people”) (Sherratt and MacLeod, 2013; Vergara and Roberts, 2011) and with more external
2 motivations (e.g. perceived pressure from others) rather than internal motivations (e.g. pleasure or valuing) (Ong and Phinney, 2002; Sherratt, 2011). The degree of internal, as opposed to external, motivation for goals has been termed goal self-concordance (Sheldon and Elliot, 1999). Avoidant and external motivations have been shown to prospectively predict negative changes in wellbeing and self-evaluation (Coats et al., 1996; Elliot et al., 1997; Sheldon and Elliot, 1999; Sheldon et al., 2004), compared to approach-oriented and internal motivations. These findings are consistent with a proposal that avoidant and externally-motivated goal-striving might perpetuate negative affective states (Elliot, 2006; Sheldon and Elliot, 1999). Motivations have not been examined among people experiencing persecutory delusions. Depression has shown high prevalence in this group, accompanied by cognitive features similar to those seen in major depressive disorder (Vorontsova et al., 2013), and may analogously be associated with the same disruptions in motivation that have been found in groups without psychosis. Disruptions in motivation could feasibly contribute to delusion persistence. In particular, avoidant motivations may drive behavioural avoidance of feared situations, and thus reduce the probability of delusional belief disconfirmation, by restricting the individual's contact with information in the environment. Improving our understanding of maintenance factors can facilitate further refinement of evidence-based therapies. The present study examined the goals and motivations of a group experiencing persecutory delusions. We hypothesised that higher depression scores would be associated with fewer approach motivations, more avoidance motivations and lower self-concordance of goals. This would constitute a replication of the pattern of effects previously seen between depression and goal motivations, but now for the first time in a group with persecutory delusions. We additionally examined associations of goal motivations with levels of paranoia,
3 and hypothesised that higher paranoia levels would be associated with more avoidance motivations. 2. Method The study used a cross-sectional between-subjects design to examine hypothesised associations between the constructs of interest. 2.1 Participants Individuals with current persecutory delusions and schizophrenia-spectrum diagnoses (N = 30; 15 males; Mage = 35, SD = 12, range 19-66) were recruited from outpatient services in London. 2.2 Measures Delusion severity was measured using the Psychotic SYmptoms RATing Scales: Delusions scale (PSYRATS; Haddock et al., 1999). Paranoid thinking was measured using the Green et al. Paranoid Thoughts Scale (GPTS; Green et al., 2008).Depression was measured using the Beck Depression Inventory (BDI-II; Beck et al., 1996). Participants identified goals for the next year, and were prompted using common valued life domains, as in previous studies (e.g. Vincent et al., 2004). Participants selected three most important goals; motivations and self-concordance were assessed for each of these, as follows. Participants listed all of their reasons to pursue the goal. These were classified as approach or avoidance, following Sherratt and MacLeod (2013). Goal selfconcordance (internal vs. external motivation) was assessed following Sheldon and Elliot (1999). Participants were asked to rate 0-10 their agreement with four statements, relating to internal and external motivations. A compound self-concordance score was calculated by subtracting external from internal ratings. Visual Analogue Scales (VAS) regarding anxiety, sadness and happiness were administered before and after the assessment procedure, to check for any emotional changes,
4 in view of the novelty of the assessment procedure for this group. Several further measures were included in the assessment protocol, whose description lies beyond the scope of this short communication. The authors will be happy to provide more information upon request. 3. Results Table 1 presents descriptive statistics of participants' scores on the study measures. Participants identified 437 goals in total. The content category with most goals identified (56 in total) was 'Education, training and learning.'
Depression was significantly positively correlated with avoidance motivations, rs(28) = 0.36, p = 0.048, two-tailed, but not with approach motivations, rs(28) = -0.22, p = 0.25. There was a significant negative correlation between depression and self-concordance scores rs(28) = -0.37, p = 0.04. Paranoia was significantly positively correlated with avoidance motivations, rs (28) = 0.38, p = 0.04, but showed no significant correlation with approach motivations, rs (28) = -0.29, p = 0.13, or self-concordance, rs (28) = 0.05, p = 0.79. Three of the four study hypotheses were thus supported: higher depression scores were associated with more avoidance motivations and lower self-concordance of personal goals, and higher paranoia scores were associated with more avoidance motivations. Sadness ratings were significantly lower (F(1,58) = 6.13, p = 0.02) at the end of the goal assessment (M = 27.70, SD = 25.39) than at the beginning (M = 45.27, SD = 29.42). Happiness ratings appeared to be higher at the end of the assessment (M = 59.80, SD = 21.18) than at the beginning (M = 48.83, SD = 21.82), but this effect only approached significance F(1,58) = 3.90, p = 0.053).
5
4. Discussion The present study examined empirically, for the first time, the relationship between symptoms and motivations in people experiencing persecutory delusions. Higher depression scores were associated with more avoidant motivations and lower goal self-concordance, as has been found in groups without psychosis (Coats et al., 1996; Ong and Phinney, 2002; Sherratt, 2011; Sherratt and MacLeod, 2013; Vergara and Roberts, 2011). These findings are consistent with assertions that avoidant and externally-driven goal pursuit may perpetuate negative affective and functional consequences (Elliot, 2006; Sheldon and Elliot, 1999). Our correlational results cannot, however, determine causality, and are interpreted with caution in view of the modest sample size. Our hypothesis that higher depression scores would be associated with fewer approach motivations was not supported. It may be that the pattern of such effects differs in this population from those used in studies of depression, or that our study was not powered to detect such an effect. The novel finding that higher paranoia scores were associated with more avoidant motivations tentatively suggests that avoidance and paranoia could be causally related, although this cannot be inferred from the present results and warrants further investigation. An avoidant motivational style might help to explain the prevalence of safety behaviours in this group (Freeman et al., 2007), which are by definition motivationally-avoidant acts intended to avert feared harm. Participants reported significantly lower sadness ratings at the end of the assessment process than at the start, suggesting that identifying goals and motivations may have had a positive impact on mood.
6 The findings from the present study suggest that therapeutic support of individuals to work towards goals motivated by approach rather than avoidance, and by internal rather than external motivations, could have the potential to improve clinical outcomes. Such effects would need to be established in future research.
References Beck, A. T., Steer, R. A., Brown, G. K., 1996. Beck Depression Inventory-II. San Antonio, TX. Coats, E. J., Janoff-Bulman, R., Alpert, N., 1996. Approach versus avoidance goals: differences in self-evaluation and well-being. Pers. Soc. Psychol. B. 22(10), 1057– 1067. Elliot, A. J., 2006. The hierarchical model of approach-avoidance motivation. Motiv. Emotion 30(2), 111–116. Elliot, A. J., Sheldon, K. M., Church, M. A., 1997. Avoidance personal goals and subjective well-being. Pers. Soc. Psychol. B. 23(9), 915–927. Freeman, D., Garety, P. A., 2014. Advances in understanding and treating persecutory delusions: a review. Soc. Psych. Psych. Epid. 49(8), 1179–1189. Freeman, D., Garety, P. A., Kuipers, E., Fowler, D., Bebbington, P. E., Dunn, G., 2007. Acting on persecutory delusions: the importance of safety seeking. Behav. Res. Ther. 45(1), 89–99. Green, C. E. L., Freeman, D., Kuipers, E., Bebbington, P., Fowler, D., Dunn, G., Garety, P. A., 2008. Measuring ideas of persecution and social reference: the Green et al. paranoid thought scales (GPTS). Psychol. Med. 38(1), 101–111.
7 Haddock, G., McCarron, J., Tarrier, N., Faragher, E. B., 1999. Scales to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS). Psychol. Med. 29(4), 879–889. Ong, A. D., & Phinney, J. S., 2002. Personal goals and depression among Vietnamese American and European American young adults: a mediational analysis. J. Soc. Psychol. 142(1), 97–108. Sheldon, K. M., Elliot, A. J., 1999. Goal striving, need satisfaction, and longitudinal wellbeing: the self-concordance model. J. Pers. Soc. Psychol. 76(3), 482–497. Sheldon, K. M., Ryan, R. M., Deci, E. L., Kasser, T., 2004. The independent effects of goal contents and motives on well-being: it’s both what you pursue and why you pursue it. Pers. Soc. Psychol. B. 30(4), 475–486. Sherratt, K. A. L., 2011. Approach and avoidance goals and self-concordance in depressed and non-depressed individuals (Doctoral thesis). University of London, UK. Retrieved from British Library E-Theses Online Service. (EThOS ID: uk.bl.ethos.583258) Sherratt, K. A. L., MacLeod, A. K., 2013. Underlying motivation in the approach and avoidance goals of depressed and non-depressed individuals. Cognition Emotion 27(8), 1432–1440. Vergara, C., Roberts, J. E., 2011. Motivation and goal orientation in vulnerability to depression. Cognition Emotion 25(7), 1281–1290. Vincent, P. J., Boddana, P., MacLeod, A. K., 2004. Positive life goals and plans in parasuicide. Clin. Psychol. Psychot. 11(2), 90–99. Vorontsova, N., Garety, P., & Freeman, D., 2013. Cognitive factors maintaining persecutory delusions in psychosis: the contribution of depression. J. Abnorm. Psychol. 122(4), 1121–1131.
8
Table 1. Descriptive statistics of participants’ scores on all study measures. Motivation numbers and self-concordance scores are summed for three top goals. Measure
Mean (SD)
Range
PSYRATS total
15.33 (3.93)
5-23
GPTS Paranoia
102.06 (39.00)
32-171
BDI Depression
21.02 (11.02)
3-43
Approach motivations
6.30 (3.17)
1-14
Avoidance motivations
2.37 (1.83)
0-8
25.23 (20.62)
-9-60
14.57 (6.55)
5-34
Goals by category: Family relationships
1.73 (1.31)
0-4
Social relationships
1.17 (1.09)
0-5
Romantic relationships
0.73 (0.78)
0-3
Education, training, learning
1.87 (1.01)
0-4
Employment, career
1.33 (1.21)
0-6
Hobbies, leisure
1.80 (1.47)
0-6
Volunteering, charity
0.80 (0.76)
0-3
Physical health
1.47 (1.07)
0-4
Spirituality
0.97 (1.03)
0-4
Mental health
1.80 (1.69)
0-8
Other
0.90 (1.16)
0-4
Self-concordance Goals identified
Note: PSYRATS = Psychotic Symptoms RATing Scale; GPTS = Green et al. Paranoid Thoughts Scale; BDI = Beck Depression Inventory.
9 Highlights 1. We examined the goals and underlying motivations of people with persecutory delusions 2. Depression was associated with goals driven by avoidant and external motivations 3. Higher paranoia was also associated with avoidant goals 4. Assessment of motivations underlying goals might be helpful in psychological therapies
www.elsevier.com/locate/psychres
PII: DOI: Reference:
S0165-1781(16)31105-2 http://dx.doi.org/10.1016/j.psychres.2017.04.041 PSY10467
To appear in: Psychiatry Research Received date: 29 June 2016 Revised date: 20 April 2017 Accepted date: 21 April 2017 Cite this article as: Natasha Vorontsova and Lyn Ellett, Depression, goals and motivations in people with persecutory delusions, Psychiatry Research, http://dx.doi.org/10.1016/j.psychres.2017.04.041 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
1
Depression, goals and motivations in people with persecutory delusions Dr Natasha Vorontsova and Dr Lyn Ellett*. Royal Holloway, University of London, London, UK. *
Corresponding author: Dr Lyn Ellett, telephone: +44 1784 414049, [email protected]. Abstract Goals motivated by avoidance, rather than approach, and by external, rather than
internal, motivations, have been implicated in the persistence of depression. This paper reports the first empirical investigation of the goals and motivations of individuals experiencing persecutory delusions. Participants completed assessments of goals and motivations, depression and paranoia. Higher levels of depression were associated with more avoidant motivations and lower goal self-concordance, but not with numbers of approach motivations. More avoidant motivations were also associated with greater paranoia. The findings are consistent with proposals that avoidant and externally-motivated goal pursuit could contribute to symptom persistence.
Keywords: Delusions, Goals, Motivations
1. Introduction Persecutory delusions are thought to be maintained by some of the same processes that perpetuate depression (Freeman and Garety, 2014). A growing area of research concerns motivations, which drive goal-directed behaviour. Studies of depressed and non-clinical groups have indicated that depression is associated with more avoidant motivations (e.g. “to not get into debt”), relative to approach motivations (e.g. “to meet like-minded people”) (Sherratt and MacLeod, 2013; Vergara and Roberts, 2011) and with more external
2 motivations (e.g. perceived pressure from others) rather than internal motivations (e.g. pleasure or valuing) (Ong and Phinney, 2002; Sherratt, 2011). The degree of internal, as opposed to external, motivation for goals has been termed goal self-concordance (Sheldon and Elliot, 1999). Avoidant and external motivations have been shown to prospectively predict negative changes in wellbeing and self-evaluation (Coats et al., 1996; Elliot et al., 1997; Sheldon and Elliot, 1999; Sheldon et al., 2004), compared to approach-oriented and internal motivations. These findings are consistent with a proposal that avoidant and externally-motivated goal-striving might perpetuate negative affective states (Elliot, 2006; Sheldon and Elliot, 1999). Motivations have not been examined among people experiencing persecutory delusions. Depression has shown high prevalence in this group, accompanied by cognitive features similar to those seen in major depressive disorder (Vorontsova et al., 2013), and may analogously be associated with the same disruptions in motivation that have been found in groups without psychosis. Disruptions in motivation could feasibly contribute to delusion persistence. In particular, avoidant motivations may drive behavioural avoidance of feared situations, and thus reduce the probability of delusional belief disconfirmation, by restricting the individual's contact with information in the environment. Improving our understanding of maintenance factors can facilitate further refinement of evidence-based therapies. The present study examined the goals and motivations of a group experiencing persecutory delusions. We hypothesised that higher depression scores would be associated with fewer approach motivations, more avoidance motivations and lower self-concordance of goals. This would constitute a replication of the pattern of effects previously seen between depression and goal motivations, but now for the first time in a group with persecutory delusions. We additionally examined associations of goal motivations with levels of paranoia,
3 and hypothesised that higher paranoia levels would be associated with more avoidance motivations. 2. Method The study used a cross-sectional between-subjects design to examine hypothesised associations between the constructs of interest. 2.1 Participants Individuals with current persecutory delusions and schizophrenia-spectrum diagnoses (N = 30; 15 males; Mage = 35, SD = 12, range 19-66) were recruited from outpatient services in London. 2.2 Measures Delusion severity was measured using the Psychotic SYmptoms RATing Scales: Delusions scale (PSYRATS; Haddock et al., 1999). Paranoid thinking was measured using the Green et al. Paranoid Thoughts Scale (GPTS; Green et al., 2008).Depression was measured using the Beck Depression Inventory (BDI-II; Beck et al., 1996). Participants identified goals for the next year, and were prompted using common valued life domains, as in previous studies (e.g. Vincent et al., 2004). Participants selected three most important goals; motivations and self-concordance were assessed for each of these, as follows. Participants listed all of their reasons to pursue the goal. These were classified as approach or avoidance, following Sherratt and MacLeod (2013). Goal selfconcordance (internal vs. external motivation) was assessed following Sheldon and Elliot (1999). Participants were asked to rate 0-10 their agreement with four statements, relating to internal and external motivations. A compound self-concordance score was calculated by subtracting external from internal ratings. Visual Analogue Scales (VAS) regarding anxiety, sadness and happiness were administered before and after the assessment procedure, to check for any emotional changes,
4 in view of the novelty of the assessment procedure for this group. Several further measures were included in the assessment protocol, whose description lies beyond the scope of this short communication. The authors will be happy to provide more information upon request. 3. Results Table 1 presents descriptive statistics of participants' scores on the study measures. Participants identified 437 goals in total. The content category with most goals identified (56 in total) was 'Education, training and learning.'
Depression was significantly positively correlated with avoidance motivations, rs(28) = 0.36, p = 0.048, two-tailed, but not with approach motivations, rs(28) = -0.22, p = 0.25. There was a significant negative correlation between depression and self-concordance scores rs(28) = -0.37, p = 0.04. Paranoia was significantly positively correlated with avoidance motivations, rs (28) = 0.38, p = 0.04, but showed no significant correlation with approach motivations, rs (28) = -0.29, p = 0.13, or self-concordance, rs (28) = 0.05, p = 0.79. Three of the four study hypotheses were thus supported: higher depression scores were associated with more avoidance motivations and lower self-concordance of personal goals, and higher paranoia scores were associated with more avoidance motivations. Sadness ratings were significantly lower (F(1,58) = 6.13, p = 0.02) at the end of the goal assessment (M = 27.70, SD = 25.39) than at the beginning (M = 45.27, SD = 29.42). Happiness ratings appeared to be higher at the end of the assessment (M = 59.80, SD = 21.18) than at the beginning (M = 48.83, SD = 21.82), but this effect only approached significance F(1,58) = 3.90, p = 0.053).
5
4. Discussion The present study examined empirically, for the first time, the relationship between symptoms and motivations in people experiencing persecutory delusions. Higher depression scores were associated with more avoidant motivations and lower goal self-concordance, as has been found in groups without psychosis (Coats et al., 1996; Ong and Phinney, 2002; Sherratt, 2011; Sherratt and MacLeod, 2013; Vergara and Roberts, 2011). These findings are consistent with assertions that avoidant and externally-driven goal pursuit may perpetuate negative affective and functional consequences (Elliot, 2006; Sheldon and Elliot, 1999). Our correlational results cannot, however, determine causality, and are interpreted with caution in view of the modest sample size. Our hypothesis that higher depression scores would be associated with fewer approach motivations was not supported. It may be that the pattern of such effects differs in this population from those used in studies of depression, or that our study was not powered to detect such an effect. The novel finding that higher paranoia scores were associated with more avoidant motivations tentatively suggests that avoidance and paranoia could be causally related, although this cannot be inferred from the present results and warrants further investigation. An avoidant motivational style might help to explain the prevalence of safety behaviours in this group (Freeman et al., 2007), which are by definition motivationally-avoidant acts intended to avert feared harm. Participants reported significantly lower sadness ratings at the end of the assessment process than at the start, suggesting that identifying goals and motivations may have had a positive impact on mood.
6 The findings from the present study suggest that therapeutic support of individuals to work towards goals motivated by approach rather than avoidance, and by internal rather than external motivations, could have the potential to improve clinical outcomes. Such effects would need to be established in future research.
References Beck, A. T., Steer, R. A., Brown, G. K., 1996. Beck Depression Inventory-II. San Antonio, TX. Coats, E. J., Janoff-Bulman, R., Alpert, N., 1996. Approach versus avoidance goals: differences in self-evaluation and well-being. Pers. Soc. Psychol. B. 22(10), 1057– 1067. Elliot, A. J., 2006. The hierarchical model of approach-avoidance motivation. Motiv. Emotion 30(2), 111–116. Elliot, A. J., Sheldon, K. M., Church, M. A., 1997. Avoidance personal goals and subjective well-being. Pers. Soc. Psychol. B. 23(9), 915–927. Freeman, D., Garety, P. A., 2014. Advances in understanding and treating persecutory delusions: a review. Soc. Psych. Psych. Epid. 49(8), 1179–1189. Freeman, D., Garety, P. A., Kuipers, E., Fowler, D., Bebbington, P. E., Dunn, G., 2007. Acting on persecutory delusions: the importance of safety seeking. Behav. Res. Ther. 45(1), 89–99. Green, C. E. L., Freeman, D., Kuipers, E., Bebbington, P., Fowler, D., Dunn, G., Garety, P. A., 2008. Measuring ideas of persecution and social reference: the Green et al. paranoid thought scales (GPTS). Psychol. Med. 38(1), 101–111.
7 Haddock, G., McCarron, J., Tarrier, N., Faragher, E. B., 1999. Scales to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS). Psychol. Med. 29(4), 879–889. Ong, A. D., & Phinney, J. S., 2002. Personal goals and depression among Vietnamese American and European American young adults: a mediational analysis. J. Soc. Psychol. 142(1), 97–108. Sheldon, K. M., Elliot, A. J., 1999. Goal striving, need satisfaction, and longitudinal wellbeing: the self-concordance model. J. Pers. Soc. Psychol. 76(3), 482–497. Sheldon, K. M., Ryan, R. M., Deci, E. L., Kasser, T., 2004. The independent effects of goal contents and motives on well-being: it’s both what you pursue and why you pursue it. Pers. Soc. Psychol. B. 30(4), 475–486. Sherratt, K. A. L., 2011. Approach and avoidance goals and self-concordance in depressed and non-depressed individuals (Doctoral thesis). University of London, UK. Retrieved from British Library E-Theses Online Service. (EThOS ID: uk.bl.ethos.583258) Sherratt, K. A. L., MacLeod, A. K., 2013. Underlying motivation in the approach and avoidance goals of depressed and non-depressed individuals. Cognition Emotion 27(8), 1432–1440. Vergara, C., Roberts, J. E., 2011. Motivation and goal orientation in vulnerability to depression. Cognition Emotion 25(7), 1281–1290. Vincent, P. J., Boddana, P., MacLeod, A. K., 2004. Positive life goals and plans in parasuicide. Clin. Psychol. Psychot. 11(2), 90–99. Vorontsova, N., Garety, P., & Freeman, D., 2013. Cognitive factors maintaining persecutory delusions in psychosis: the contribution of depression. J. Abnorm. Psychol. 122(4), 1121–1131.
8
Table 1. Descriptive statistics of participants’ scores on all study measures. Motivation numbers and self-concordance scores are summed for three top goals. Measure
Mean (SD)
Range
PSYRATS total
15.33 (3.93)
5-23
GPTS Paranoia
102.06 (39.00)
32-171
BDI Depression
21.02 (11.02)
3-43
Approach motivations
6.30 (3.17)
1-14
Avoidance motivations
2.37 (1.83)
0-8
25.23 (20.62)
-9-60
14.57 (6.55)
5-34
Goals by category: Family relationships
1.73 (1.31)
0-4
Social relationships
1.17 (1.09)
0-5
Romantic relationships
0.73 (0.78)
0-3
Education, training, learning
1.87 (1.01)
0-4
Employment, career
1.33 (1.21)
0-6
Hobbies, leisure
1.80 (1.47)
0-6
Volunteering, charity
0.80 (0.76)
0-3
Physical health
1.47 (1.07)
0-4
Spirituality
0.97 (1.03)
0-4
Mental health
1.80 (1.69)
0-8
Other
0.90 (1.16)
0-4
Self-concordance Goals identified
Note: PSYRATS = Psychotic Symptoms RATing Scale; GPTS = Green et al. Paranoid Thoughts Scale; BDI = Beck Depression Inventory.
9 Highlights 1. We examined the goals and underlying motivations of people with persecutory delusions 2. Depression was associated with goals driven by avoidant and external motivations 3. Higher paranoia was also associated with avoidant goals 4. Assessment of motivations underlying goals might be helpful in psychological therapies