How do people recover from persecutory delusions? An interpretative phenomenological analysis

Abstract

Background Patient perspectives on recovery from psychosis have been studied. However, there are few studies on recovery from particular psychotic experiences. Persecutory delusions are common, often distressing, and can disrupt day-to-day life and relationships. We explored how patients report recovering from persecutory delusions. Methods Semi-structured interviews were completed with 15 patients who had recovered from persecutory delusions. Interpretative Phenomenological Analysis was used. Results Three superordinate themes were identified. The first was “Foundational background features set the context for recovery”. A range of features, including support and respect from others, routine, calm environments, and medication, provided the basis for recovery. The second superordinate theme was “Activity as a route for positivity and re-engagement with the world”. Engagement in activity was important to re-orient attention away from paranoid fears, and to improve mood. The third superordinate theme was “The effortful discovery of safety”. Generating, considering, and testing alternative explanations was a key route to learning safety. Discussion Recovery from persecutory delusions can take many routes, which vary between individuals. Supporting individuals to reengage with activity and generate acceptable and sufficiently-evidenced alternatives to paranoid fears are potentially valuable treatment targets in the processes of recovery from paranoia.