How does attachment imagery reduce paranoia? The role of cognitive content (beliefs) and process (fusion)

Paranoia is characterised by unfounded interpersonal threat beliefs, and fusion with these beliefs. Attachment imagery fosters a sense of ‘felt security’ in people with non-clinical and clinical paranoia. Little is known about the mechanisms of change. Models of paranoia differ in terms of the weight placed on cognitive
content and process, and therefore whether therapeutic interventions should focus on addressing beliefs or relationship with beliefs. We present two linked studies examining the role of self- and other beliefs, and cognitive fusion, in the impact of attachment imagery. We used a randomized experimental design and recruited people with non-clinical paranoia (n=117; n=303) to test the impact of secure and insecure attachment imagery, and causal mechanisms. Secure imagery led to reduced paranoia and anxiety, and improved help-seeking, compared with insecure imagery. Self- and other-beliefs, and cognitive fusion mediated the impact on paranoia and anxiety, but not help-seeking. We found larger effects for cognitive fusion. These studies suggest that secure attachment imagery is likely to benefit people with paranoia, and operate via both cognitive content (beliefs) and process (fusion).