Threatening thoughts in first episode psychosis : the experience of content, emotional distress, change over time and context

The subjective experience of paranoia and persecutory delusions is largely overlooked in the extant literature, especially in first episode psychosis (FEP).
This study explored the personal experience and understanding of threatening thoughts in FEP, guided by three over-arching research questions addressing: thought content and emotional distress; the role of life events and context; change in experience over time.
Semi-structured interviews were conducted with eight participants. Transcripts were analysed using Interpretative Phenomenological Analysis.
Five master themes were identified reflecting recurring characteristics of all participants’ experiences: Exposure of vulnerable self; At the limits of endurance; Elusive sense of agency; The urge to explain it all and FEP as a finite experience? 16 sub-themes indicated elements of master themes that varied among individual narratives.
Findings indicated the highly interpersonal nature of threatening thoughts and their role as a key organising factor in people’s lives. Emotional distress was often viewed as consequential to multiple types of thought content, overwhelming pressure, powerlessness and expectation of negative judgement. Difficult life contexts often seemed to contribute to thought manifestation. Reduction of novelty was important to positive change. Several participants framed experiences as terrible but completed, rather than as the beginning of chronic difficulties.