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.

www.nationalparanoianetwork.org

peterbullimore@yahoo.co.uk