The causal role of attachment in paranoia: key mechanisms and implications for cognitive behavioural therapists

Introduction. Paranoia describes unfounded interpersonal threat beliefs. Attachment theory proposes that early interpersonal relationships lead to the development of attachment styles, which affect how we think, feel, and behave in relation to others.
There is robust evidence that insecure attachment styles are associated with elevated paranoia, though no evidence that attachment causes paranoia and little information about the mechanisms involved. Researching the causal role of attachment in paranoia and key mechanisms informs cognitive behavioural interventions for paranoia, for which outcomes remain variable.
Method. Across two experimental studies in people with high non-clinical paranoia, we manipulate attachment security using
imagery priming to test whether insecure (vs. secure) attachment priming increases paranoia, and whether key cognitive and
affective mechanisms mediate this impact.
Results. The results show that attachment causally influences paranoia, with insecure attachment priming increasing paranoia
and secure priming reducing it. The findings show that insecure attachment elevates paranoia via negative beliefs about self
and others, cognitive fusion (becoming entangled in thoughts and beliefs), and use of unhelpful emotion regulation strategies
(e.g., rumination and suppression).
Discussion. The results suggest attachment is a causal factor influencing paranoia, and that both cognitive content (what we
think) and process (how we think) impacts paranoia. People with paranoia use emotion regulation strategies consistent with their attachment styles, but this is not targeted routinely in CBT. We are now using this research to inform treatments for psychosis to improve recovery outcomes in people with paranoia who also have insecure attachment styles