Understanding Experiences of Feeling Exceptional: questionnaire study
Research type
Research Study
Full title
Understanding Experiences of Feeling Exceptional: A Clinical Questionnaire Study
IRAS ID
285404
Contact name
Louise Isham
Contact email
Sponsor organisation
University of Oxford - Clinical Trials & Research Governance
Duration of Study in the UK
1 years, 2 months, 31 days
Research summary
Research Summary
Grandiose delusions are unfounded beliefs that one has special powers, wealth, mission, or identity. They are common delusions experienced by those diagnosed with schizophrenia or bipolar disorder and can be harmful (e.g. believing one is invincible and walking out into traffic).
The overarching aim of our research programme is to develop the first talking therapy for harmful grandiose delusions. To do this, we must first understand what psychological factors ‘drive’ grandiose delusions (i.e. keep them going) in patients. This is the primary aim of the current study. A secondary aim is to assess the quality of four new measures which assess some of these psychological factors.
Over 500 patients with diagnoses of psychosis will answer questionnaires (20-40 minutes) measuring grandiose beliefs and six psychological mechanisms that we think drive grandiose beliefs. These are:
(i) The meaning of the grandiose belief
(ii) Anomalous experiences (e.g. hearing voices)
(iii) Mania
(iv) ‘Fantasy elaboration’ (repetitively thinking about the belief).
(v) Reasoning biases
(vi) ‘Immersion behaviours’ (acting ‘in role’ in accordance with the grandiose belief).Most participants will answer questionnaires on a single occasion. A small subgroup of around 100 participants will repeat some measures again one week later, so that we can see whether the results from the new measures (which measure ‘meaning’, ‘fantasy elaboration’ and ‘immersion behaviours’) are stable over time.
We will use ‘network analyses’- a technique based on probability estimations - to understand the associations and likely causal relationships between these psychological mechanisms and grandiose delusions.
To reach large numbers of patients we will recruit participants via the Clinical Research Network (CRN) which has research assistants placed in NHS Trusts nationwide (a method successfully used previously by our research group). Participants will be offered £5 for their time. The study is funded by the National Institute for Health Research (NIHR).
Summary of Results
Background: Grandiose delusions are inaccurate beliefs about having special powers, wealth, mission, or identity. They can become problematic when harmful actions ensue (for example believing one can fly and stepping off high objects, or that one can walk on water and attempting to do so in heavy clothing in deep water). Because of the harm that can occur, our overarching goal is to develop a psychological (talking) therapy that will reduce harmful grandiose delusions.
Study aims: In this study we wanted to find out two things that will help us to move towards this goal. Firstly we wanted to know the extent to which patients identify harmful consequences occurring as a result of grandiose delusions. This is important as if people themselves identify difficulties and want help then this might offer a route to engage patients in therapy. Secondly, we wanted to find out more about what psychological processes might keep grandiose delusions going, as these processes might be potential targets for a psychological talking therapy. We were interested in processes such as: i) the meaning that the belief might provide (for example giving someone a sense of purpose for the future), ii) spending a lot of time thinking about the grandiose belief, and iii) ‘immersion behaviours’ (acting in line with the belief) for example going out ‘blessing’ others whilst believing one is Jesus.
Who took part: 798 patients who had been given a diagnosis of psychosis and were currently open to adult mental health services in the UK took part in this study. Participants completed a range of questionnaires.
What we found: In relation to harmful consequences from grandiose delusions we found that:
i) More than three-quarters of patients who had experienced grandiose delusions reported associated difficulties occurring within the last six months.
ii) Patients reported these difficulties occurring across multiple areas of their lives (including physical, sexual, social, emotional, and occupational).
iii) More than half of patients wanted help with these difficulties.
In relation to psychological processes that might keep grandiose delusions going we found that:
i) Grandiose delusions were experienced as very meaningful, providing a sense that one’s life makes sense, is worthwhile, and has a purpose for a future. Patients who reported their grandiose beliefs as more meaningful tended to have greater severity of grandiosity.
ii) Repetitively thinking about the grandiose belief was also associated with grandiosity. The more someone thinks about their belief, the more certain they are that it is true and the greater the severity of grandiosity.
iii) Similarly, immersion behaviours were also associated with grandiosity so that the more a person acted on their beliefs, the higher the level of grandiosity.What this means: These results show us that most patients with grandiose delusions identify harm or difficulties arising from these beliefs and this may provide a route for engagement in treatment. Furthermore, the meaning in grandiose delusions, repetitive thinking about the belief, and acting in line with the belief are each associated with increased grandiosity and may keep grandiose delusions going. However, because there were limitations to the study (for example we only collected data at a single time point) more research is needed before we can be certain that these processes keep grandiosity going.
If this turns out to be the case, then the meaning in grandiose delusions, repetitive thinking about the belief, and immersion behaviours may be potential targets for a talking therapy. It will be important for clinicians to hold in mind that, because grandiose beliefs provide a sense of meaning in life, it could be harmful to try to change the belief without first supporting the patient to build up a sense of their life being meaningful from other sources. This may be an important focus for the therapy – supporting the patient to build up meaningful activity to reduce the extent to which the grandiose belief is needed to provide a sense of meaning in life, whilst also leaving less time to engage in repetitive thinking about grandiose beliefs and immersion behaviours.REC name
South Central - Oxford C Research Ethics Committee
REC reference
20/SC/0430
Date of REC Opinion
8 Dec 2020
REC opinion
Favourable Opinion