OK, let's make a start. Thank you very much for joining us today for the latest in our mental wellness series brought to you by
the Department of Experimental Psychology here in the University of Oxford at my name's Kathy Creswell,
and I'm delighted to introduce you today to Professor Daniel Freeman, who's going to be talking to us about overcoming mistrust and paranoia.
And we're going to have a short talk from Daniel and then I'll introduce you to the other members of our panel here.
Thanks to those of you who submitted questions, which our panel will be discussing.
Before we get started, though, just wanted to give you a couple of reminders.
So this is part of a series that we've now had a number of talks over the last year.
So please do at the Department of Experimental Psychology website or our YouTube channel to watch back previous talks with some fantastic ones,
including sessions on coping with trauma disorders, depression and low mood sleep problems, stress and anxiety.
And our next session will be on bullying and anxiety. And that will be on the 3rd of June at 10:00 a.m. So please do join us then.
Also, just a reminder that obviously we are talking about subjects that can be difficult for people.
So we deliberately set all of our sessions that there are no more than 45 minutes long.
And hopefully that means you get the opportunity for a little bit of a break before your next appointment or activity or commitment.
So we'd like to really encourage you to use that time to step away and help anyone to chat to you if you need it.
But just to give yourself a little bit of a break or thinking space before you move on to the next thing.
But without further ado, I'm going to now hand over to Daniel Freeman.
And Daniel is professor of clinical psychology in the Department of Psychiatry and the
fellow at University College and also a consultant clinical psychologist in Oxford Health.
And we're really looking forward to. Thanks very much for joining us. Thank you, Kathy, and welcome, everyone.
It's a delight to have you join us. So.
Bedrock of our daily life is trust.
We need to trust that it's safe to step out the front door.
That the people around us, when we walk down the street, we're going to shop, will treat us well if we use our credit cards in a shop,
if you're on a bicycle, that motorists won't deliberately try to knock us off, that we can share confidences with friends and colleagues.
And our route home at the end of the day is safe.
We, to a degree, need to trust the people that we see and also people that we don't see because otherwise we won't be able to do anything.
And as Graham Greene put it, it is impossible to go through life without trust, that is, to be imprisoned in the worst cell of all oneself.
Without trust, the only person you can truly be with is yourself, and that's not good for your psychological health.
It also means your life becomes restricted and that's bad for your physical health.
And there's evidence the mistrust associated with high blood pressure, heart problems and diabetes.
But of course, you might say that if you just trust everyone, naturally, you're being naive, gullible, credulous and easy touch wet behind the ears,
showing a wide eyed innocence to the world because there are people out there with bad intentions and bad behaviours.
Mistrust is not always misplaced. We have to find a balance between trust, mistrust, and, of course, that can vary between person, place and time.
But what I do think is that overall in our society environment, there's been for a while now a gnawing away,
an erosion of trust between people rather than a growth of trust in our society.
I just want to sort of pick out a few pertinent examples that start off with first about vaccines,
which are obviously crucial at the moment, because that's the way of the current crisis.
We did a survey back in October last year looking at sort of conspiracy beliefs around vaccines,
for example, that the safety data or effectiveness effectiveness data are made up.
And what we showed, around 20 percent of the population, UK adult population endorses these beliefs to some extent,
but also about one in four, 25 percent of people are neutral about this.
They don't agree or disagree with these sorts of ideas.
And you can see the sort of form of mistrust that concerns about science, also in general, official explanations about the pandemic.
So, for example, I believe that the virus is a hoax. Only 72 percent of the population do not agree with that.
Well, you've got another 20 percent agreeing with that or being unsure about those ideas.
Only half the population, adult population, according to this survey,
do not agree with the idea of the virus spread as a deliberate attempt to reduce the size of the global population.
And again, only 70 percent agree that I don't agree with the idea that the vaccine to be used to current mass sterilisation.
So you're seeing this obvious mistrust of official explanations and misinformation taking root and said and of course,
that's probably not surprising because we've had a long period now what even facts are attacked.
And in 2016, the Oxford Dictionary declared post truth is international word of the word of the year,
reflecting what it called a highly charged political 12 months. Heaven knows how they would describe the subsequent to that.
And there was a powerful bit in Joe Biden's inaugural speech where he said there is truth and there are lies, lies tough for power and for profit.
And each of us has a duty and responsibilities as citizens, as Americans and as leaders to defend the truth and defeat the lies.
Powerful, but also startling that needs to be said.
Now, I focussed on a particular for mistrust, paranoia, where people have unfounded ideas,
others are deliberately trying to harm them, they're being targeted.
Now, when I started working this area in the 1990s, paranoia was primarily thought of as a symptom of mental health disorders such as schizophrenia.
And I have a vivid memory of the first patient home visit I did. A nurse told me that whatever I do,
I shouldn't knock on the front door of the patient I was going to see because he was think it's his persecutors come to kill him.
So what I had to do was scramble around the bins and through the bushes to a side
window to tap three times like I felt like a burglar who must have looked like one.
But when he answered, when I spoke to him, it was very apparent was how anxious he was.
And his defence has gone up and it restricted his life, rather like in the Graham Greene quote.
And if you think of paranoia as a form of anxiety, then it becomes much more understandable.
It also makes you think that there'll be mild variance in the population at that time.
And it wasn't really examined. So we did research around that and in fact, found that paranoia was there at much milder levels in the population.
This is some data from UK epidemiological staff sample.
What the data all points towards is that many people have a few paranoid thoughts on a few people have many.
But how do we know the actual genuine paranoid thoughts that they are inaccurate sometimes?
This could be hard fought, is more likely to be paranoid if no one else fully shares your suspicions.
There's no indisputable evidence to support your worries. There's evidence against your suspicions.
It's unlikely you would be singled out. Your fears persist despite reassurance from others.
And your fears are based on feelings, unambiguous events, and it looks like nature and nurture.
Important data from a study of 5000 adolescent twins showing that around half of the variants,
the differences in paranoia across the population, adults, genes and around half down to environment.
And when it comes to the environment, we know past experience is important.
And if people have done bad things to you, that's more likely for you to view the world through mistrust.
And we did a study of people attending accidents in emergency clinics after being physically assaulted and in the weeks
after 80 percent reported being excessively fearful of other people generalising beyond the person who had assaulted them.
And six months later, still two thirds were reported being excessively fearful of other people.
And what predicted this mistrust over time was that if a person had developed particularly negative views of themselves as well as other people.
So how do I understand paranoia and most importantly, how do I use that information to try and reduce and overcome paranoid thoughts?
Well, at the heart of paranoia is an unfounded threat, belief to thoughts.
Others are trying to harm you. And the consequences of that psychological view of paranoia is that to overcome it,
what you want people to do is develop the new belief that they're safe now to counteract the old threat beliefs,
a safety place that developed paranoid thoughts begin to melt away.
That's easier said than done because actually there's at least half a dozen factors that prevent this new learning of safety warriors,
important low self-esteem, internal sensations, sleep problems, reasoning biases, defence, and go talk through each one of those in a moment.
But fundamentally to overcome paranoia.
What we want people to do is to develop a renewed curiosity, flexibility and a way of seeing the world distancing from the paranoid thoughts,
dropping those defences and experience the world anew to make new learning.
And what we try and do before and to help people to be able to do that is to take down the temperature a bit.
So, for example, we address Worryin rumination, and a person said to me that he sits and thinks,
then gets paranoid and paranoid and paranoid and paranoid.
The more people worry, the more implausible ideas come to mind, the more they're elaborated on, the more distressing experience.
And what people are doing when they're just worrying is, in fact, second guessing the intentions of others.
And that's very hard to get right.
So what we help people do is realise that actually worry serves a person a purpose for the person, which is typically they believe it keeps them safe.
We help people recognise actually leads to a very skewed,
unbalanced view of the world and that it is better to confine were to brief periods of time and even better substitutes,
problem solving strategies to take a more balanced approach to the war and some false.
And negative self police, a lack of confidence often underlies paranoia because people often feel that they're worthless,
one lovable and they feel inferior to other people. They feel all and apart and different and therefore vulnerable.
And paranoia builds upon feelings of vulnerability. So overcome paranoia.
We help people actually build up also their positive views themselves.
We hope we help people reflect on their strengths and their values and get them to enact that during the day through sort of positive activities.
And in that sense, the positive is the self again, comes to override the feelings of vulnerability and.
But it's also the case in paranoia over what we see is the body's alarm system, the anxiety system is being too sensitive.
It's firing when there isn't any danger, and it sets in motion a whole range of physiological effects that basically the body is yelling that
there's danger and the person is surmising that it must be coming from the people around them.
We help people to learn to tolerate those sorts of emotions and reset that clock.
What we're also very sure about is that getting good sleep helps reduce paranoia.
We carried out the largest clinical trial of a psychological intervention in
almost 4000 university students with insomnia and half had an insomnia treatment.
They didn't have any techniques to reduce paranoia, but simply by improving sleep, paranoia itself eased.
But also, it's very easy when you have an anxious thought to get caught up in it, to believe it,
to not consider any evidence that is inconsistent with it, and therefore and also not to think of alternate explanations.
You get kind of locked into one way of seeing the world or actually to get out of paranoia.
Flexibility is helpful. And there's a nice passage in the name of the Rose that describes, I think, the advantages of flexibility in thinking.
And this is a sort of dialogue between Adso, who's a sort of novice, and his teacher, the Franciscan Friar William of Baskerville.
And the dialogue goes like this, I'd say says, therefore, you don't have a single answer to your questions.
He says to William of Baskerville, I'd say if I did, I would teach theology in Paris.
In Paris, they always have the true answer, never, William said.
But they're very sure of the errors. I knew, I said with childish pertinence.
Never commit errors often, he answered. But instead of conceiving only one, I imagine many.
So I become the slave of no. And that's a reflex, he said.
I understood that my Masters method of reasoning, and it seemed to me quite alien to that of the philosopher who reasons by first principles.
So this, in fact, almost assumes the ways of the divine intellect.
I understood that when he didn't have an answer, William proposed many to himself, very different one from another.
I remained puzzled. But then I ventured to remark, You are still far from the solution.
I'm very close to him, Williams said, but I don't know which.
This is highlighting flexibility in thinking about alternative explanations for events,
but perhaps one of the greatest reasons people get kind of locked into paranoid beliefs is the defences they put up.
What happens is the fears became locked and protected behind walls, which means they don't change if the world changes.
And what's most common is the people with paranoid thoughts will avoid going into social situations.
And if they do, they will most typically try to be inconspicuous Rosch and avoid eye contact.
And what it means is they think that nothing bad has happened because they put up the defences,
not that they would have been safe without the defences and defences has consequences because you end up avoiding situations,
which means you're more inactive and that produces actually fewer chances to gain confidence.
Your confidence dip, you have more time on your hands,
you'll worry more and you'll be more alert when it comes to the evening and your rhythms will be disrupted and your sleep worse,
which means the cycle goes on and on. So what ideally we try to do in overcoming power, help people drop the defences.
Generally go back into the situations they fear and learn what is actually happening now to enable
chances for the person to learn that actually they are safe and they can cope in these situations.
And we also then do is repeat this, so we embed and consolidate the learning,
so it's about getting back into the situations we fear and finding out about how things are
now and therefore will build up these new beliefs and memories that actually the world is OK.
Fundamentally, what?
We have to think about it, this is about how we want to approach other people, the people we see and the people we don't want to see.
And one approach encapsulated in this Russian Russian rhyming proverb Dovi I know probably is trust but verify.
And this term was popularised by Ronald Reagan in discussions with Mikhail Gorbachev about nuclear disarmament.
But I'm going to finish now with just one final point.
Just in the interest of flexibility, another alternative perspective,
perhaps a less severe one on this from the author enforced who said one must be fun to people and trust them if one is not to make a mess of life.
So I'll stop that. Right, thank you very much indeed, Daniel,
and we're definitely picking up on some of the things that you've raised there for a bit more discussion in this next section.
But first of all, I'd like to introduce our panel members.
So we're joined now by Liz Tonbridge, who's associate professor in the Department of Psychiatry and a fellow at University College, and also Camporee,
who's a professor of psychiatry, also in the Department of Psychiatry and an honorary consultant psychiatrist at East London NHS Foundation Trust.
Thanks so much for joining us, Liz. And calm. So we have some questions that people submitted before the event today.
And one of them, the first one really does pick up on one of the things that Daniel raised about the increased
incidence of fears of harm by others after people have experienced traumatic events.
And somebody did highlight that bullying or trauma may lead to feelings of paranoia and mistrust.
So can paranoia be a survival instinct? Might it be something that is helpful to us?
And so I was interested in your views about that. And I'm sort of touched on this, which is that.
Essentially, you can see paranoia as being a state of kind of heightened anxiety or heightened vigilance, I suppose, to the world around you.
And if you're in a situation where the world around you is genuinely threatening, that vigilance is obviously a good thing.
You know, if you if you live in a world where there's lots of bears,
it's makes a lot of sense to be vigilant to the presence of bears if you want to stay alive.
I suppose, as Dan kind of explained, where that goes awry, where it, I suppose, becomes what we call paranoia,
is where that village vigilance and anxiety persists in the absence of the overt threat.
And so, in a sense, the concept of paranoia is almost by definition,
this feeling of anxiety and threat, even when there's no particular reason for that to be the case.
But undoubtedly, if you were in a situation that's threatening, of course, it makes sense to be to be vigilant and to be alert.
If you want to stay alive, it's a survival mechanism.
So I suppose paranoia is is sort of when that survival mechanism persists in situations where it's inappropriate.
And actually, that leads really nicely onto the next question, which which I think is about this issue of, well,
how do we know how do we know if all this is paranoia or whether there is something that we should be being careful of and vigilant to say?
The question really was, how can we balance trusting people with keeping ourselves safe?
And then can I go to you first of all on that one and then I'll come to camp?
Yeah, it is a balance. And, you know, I think when when actually you're in adverse circumstances and people are against.
I wouldn't view that as paranoia, but it definitely then makes you more vulnerable to having in the future.
Understandably. Of course,
what I what I think is fundamentally when people get the balance wrong is when they are in their own head and they're doing the second guessing.
And therefore, for me, the way to find the balance probably is three things, really.
Firstly, when you can talk to the people you trust around them both to learn from them and to share your fears, and you could do that gently.
But I think in many ways we learn what safe and unsafe from the people around us, because, of course,
there are circumstances everywhere in certain situations, although it's safe that you can get out of your head and talking to people.
And another technique often is helpful is simply for yourself to write it down.
And rather than writing down as a worry,
but just weighing up the pros and cons of different strategies so often just by saying things out loud and writing things down,
that changes our perspective on things. But most of all, I think it's avoidance that's the problem.
And therefore, any way that you can just gently test the wolf is a real best way to learn directly how things are by trying stuff out.
And I think that's the most helpful strategy in the end.
Thanks very much, Abcam. Did you want to add anything further? Just yeah, just a reflection.
I me from Daniel's point about don't be alone.
I mean, really, we need to understand why people lack trust, what their experience of learning about is, as we've seen if you've had.
Difficulties from an early age, and you continue to live with adversity and trauma that is very difficult to trust.
So actually it is a self-protection mechanism to some extent.
And what needs to be self-aware to be able to reflect on your own thoughts and judge whether your thoughts are faulty or not?
It's not always possible if you continue to be in a place of adversity and difficulty in facing distress all the time.
So it is a balance, but I think we sometimes overstate our ability to achieve that balance.
I think when people are facing paranoia and living with paranoia.
Crime and Punishment, Dostoevsky's novel, if you if you if you want to experience what Paradise is like a read the novel and
how horrible it feels to feel the world is so threatening and terrible a place,
I think sometimes we ask a lot of people will be trying to get balance.
On the other hand, there are good therapeutic techniques that Daniels talked about.
But I'm also interested in the social and how social becomes imprinted on the psychological and that the
response to intervention is also social to some extent to change the environment in which we're existing.
And that point really about the importance of the social environment and I guess
picking up on what you saying as well about not being allowed to reach out to others,
talk to others, you know, check out your your beliefs does raise a question about, you know, the context that we've had over the last year.
And there was a question submitted which was asking, is the increase in remote working and the decrease in social interaction that many
people have experienced over the last year likely to have increased paranoia.
Let's do you have any comments on that? I mean, I think undoubtedly I can't see how it wouldn't, to be honest, in a way,
we're almost living in the perfect storm where we're in a world that's inherently more threatening than it was 18 months ago.
We know that people are more isolated than they were and they're not having those social interactions,
which, you know, as we've heard from Dan, Dan and Cam, so important to address paranoia.
And we know that people aren't sleeping properly and that they're more anxious than they were.
So I can't see that this is in many ways the perfect storm of of of paranoia generating environment.
So it would be almost unbelievable to think that paranoia is not going to increase during this period.
Plus, coupled with you,
coupled with the environment we live in online that increasingly is amenable to spreading fake news about vaccines or whatever else.
I think all of these things are going to play into into this this situation,
which we are all inherently in a heightened state of anxiety and probably for very good reason in many cases.
So I think it will remain to be seen how quickly that wanes after things begin to return to whatever normal is after the pandemic.
But I think certainly in the short term, I think we're going to see really significant spikes in paranoia.
And so I suppose, given that we are still in a slightly strange context and I guess it's not completely clear how things are going to continue and,
you know, we still obviously do have many restrictions on us.
And I guess that does raise the question of how we can combat combat these difficulties, particularly in the current context.
And, you know, how we might switch off these sorts of negative feelings,
particularly at times when it's difficult to reach out to others and connect with others.
I don't know if you have any thoughts on that.
I think it's really important to point out that, listen, Daniel, I've made about being in a relationship.
We've learnt really from the lockdown how difficult it is not to be in real relationships.
Even some relationships don't really replace those real relationships within the relationship.
But we process emotions and we process traumatic memories and process adversity and come to reflect and exercise our ability
to trust and within the relationship that we can reduce to levels of anxiety and expose ourselves to alternative perspective.
So isolation is a terrible thing, I think. But also being aware of one's own ability to process emotion is important.
I think reducing levels of anxiety through other means as well.
Exercise, activity, relaxation, leisure, breaking the cycles, as Daniels outlined of worry and reflecting on more positive experiences.
All of those are helpful. At the other extreme, I know that, you know, I've done some research on extremism, for example,
and radicalisation and how digital environments can perpetuate conspiracy theories and extreme actions as a consequence
of them showing what the potential is if people aren't testing their belief systems against alternative views.
So there was lots one can do. And it comes back to self care, self awareness, listening very carefully,
looking up and noticing the other person and really taking sometimes all of these things,
of course, are difficult in modern life and particularly so with so many.
Thanks very much to you for any further thoughts on that and particularly, I guess, this challenge of connecting with others,
testing out our thoughts and beliefs about others and their intentions in this slightly strange
environment that we find ourselves where it might be harder to connect with people face to face.
Yeah, I mean, I think it is the pandemic is a perfect storm for misinformation and conspiracy thinking.
I think we're seeing that. I think it's probably less so that individual target is paranoid.
But I think there are I think this highlighted a number of reasons those vulnerable may be affected, particularly by the isolation.
So this is highlighted very nicely. The social fart's will have an influence psychological level, and it will be through tips and confidence.
More time to worry disturbs sleep and less chances, less engagement with people.
So I think. There are reasons you're vulnerable that it may persist more.
But I'm not expecting a huge increase of individual paragliders as opposed to the more sort of general mistrust of conspiracy and misinformation,
and I think we're seeing some clear markers of long standing fault lines in our society that emerged during a collective response.
But of course, we've also seen a lot of really good things and coming together and collective responses in this and the reaching out to others,
which is so crucial, I think, in in our society, but also helping people come, overcommitment difficulties, whatever they are.
Social connexion is clearly important for people and.
You know, throughout one is feel psychologically better when one is engaged in activity that is meaningful for oneself,
and the more you can do that, the more you get your head away from the worries and the fears.
There's less time in your head for that.
And comes also rightly highlighted the basis of getting a sleep and exercise and diet help you reach the emotional state of distance and thoughts.
So, you know, for all of us,
I think the pandemic is obviously a test of all of how we are managed because so much has changed for all of us dramatically.
Thank you. And you picked up there also about, you know,
the sort of keenness amongst many to be able to support others and and actually that's something that certainly
shone through in the questions we received where many people were keen to know how best to support others,
friends, family, co-workers who were showing signs of paranoia. And I guess it's always that, you know,
concern that you might somehow feed into people's worries rather than be able to be a supportive person for them.
So many people were keen to hear your thoughts on how we can best support others who might be struggling with paranoia and similar sorts of concerns,
like, can I come to you first for your thoughts? Yeah, a really important question.
And I guess one has to be clear about what role you have with another person as a friend or a family member and at the same time,
listen carefully to be aware whether what they're expressing is a heightened concern or extreme
exquisite sensitivity to awkward situations or a long history of adversity discrimination.
I mean, I do a lot of work on ethnicity in the history of discrimination ancestrally and recently.
And then Closter disadvantage and difficulty getting jobs and violence and all
of that means that some people aren't going to be in a very different place.
So don't assume that you know what their world is like and that you understand and relate to it and will be able to relate to it.
I think the most important role one can play is just to listen, to be with, to support,
to help reduce levels of worry and anxiety, to offer an opportunity to process emotions and reflect and to not be alone.
And within that process, if you see or discover concerning aspects of belief,
which are the more extreme and perhaps driven by hallucinations or delusions,
which are risky for the personalities, then you don't have to do that to yourself.
You're not no longer a friend. You have to move into a different space. And of course, I guess there's the three groups of people I've worked with,
with paranoid people with psychosis, people with personality difficulties, people from ethnic minority groups.
And each of those convey a different type of paranoia, the most extreme and if you like, which can still be managed but is worrisome.
People have had chronic adversity, adverse childhood experiences and trauma.
And I develop patterns of relating and feeling which need to be managed differently.
And those who experience social adversity and chronically over long periods of time in who
the paranoid become completely reasonable and reflect a reality that they are experiencing.
And they haven't been able to manage their way out of it or manage themselves.
And actually avoiding self attribution is one mechanism by which paranoia emerges when one has to manage difficult situations.
So I think to be as human as you can and as as ordinary as you can and don't be heroic is what I would say.
Thank you. Yeah, it sounds like really sensible advice and I'd like to come to you on this question as well.
And just to sort of pick it up a bit further.
One of the specific questions that we had is, is it best to go along with someone's beliefs or to try and convince someone otherwise?
And so maybe if you could also tell us a bit about your thoughts on that, that would be great.
Yeah, I would be thinking about two things, really. One is talking and secondly, about action, really.
So in the talk is Comer's saying, I think you have to listen and try and understand the person's perspective.
I think it's fine to introduce your perspective into this, but what you don't want to do is set up a.
An argument because that just backs people into the existing conditions,
but the opportunity to to listen while you respect and also providing your view generally is is the way.
But then also, I think to the people around you, it is providing that support.
And that's the action that really where, you know, you want to get the person out,
not avoiding, you know, being engaged in activities that are enjoyable,
meaningful, positive experiences, and also enables them to to test the waters,
even if you're not going out there to seek a psychological intervention that way.
But you're giving a person to implicitly learn it's okay to be in these situations and to learn from you.
So I think that listening and understanding,
respecting but also providing opportunities for the person to engage with the world and an away from a sort of mistrusting threat based perspective.
Thank you very much, Liz. I don't know if there's anything else you wanted to add at all, either on that question or anything else that we've covered.
Not particularly. I'm going to leave the clinical side of things to come and Daniel, who are eminently more qualified than I am, so to speak, to that.
Great. Well, thank you all very much indeed. That answers all of the questions that we'd picked out for today to focus on.
So I'd like to thank all of you for your time today.
I think it's been a really interesting and useful session, and I hope that those who have joined us have felt the same.
I just want to remind everybody who has joined us that, as I mentioned,
we've got another session in the series coming up on the 3rd of June, and that's focussed on bullying and anxiety.
I'm also pleased to complete the short feedback form that will pop up as you lead the session.
They're very useful for us.
Just to help us plan ahead and think about what how we should do things and what sort of sessions we should offer going forward.
And as I mentioned, please, to have a look at the Department of Experimental Psychology website or our YouTube channel where you can find
our previous talks are all equally have a very good combination of research findings and practical advice.
So thank you ever so much again for joining us. And we hope that you'll be able to join us again for an upcoming session.
Thanks again by.