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

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.