Vivid images of future harm: The relationship between paranoia, prospective imagery and present moment awareness

Paranoia describes an anxious over-anticipation of intentional harm from others, which is common in young adults. Whilst vivid emotional mental imagery (EMI) has an established role in understanding persecutory delusions, its association with paranoia in general population young adults is unknown. We tested whether the vividness of imagery for different types of negative future events differentiated paranoia from anxiety. Specifically, we varied future scenario content by virtue of interpersonal content and level of intentionality (non-interpersonal, interpersonal and interpersonal-intentional), as well as examining whether one’s capacity for present moment awareness moderated the relationship between negative imagery and paranoia. The design was a cross-sectional survey with UK dwelling young adults (n=120, 19.6 years). Participants completed questionnaires, including an adapted version of the Prospective Imagery Task. Paranoia was associated with experiencing more vivid negative imagery for future events that were interpersonal and intentional in nature, whereas anxiety was associated with future negative imagery of non-interpersonal content. A lower ability to remain in the present moment intensified the relationship between imagery vividness and paranoia. These findings provide a first step in understanding a potentially important relationship between prospective imagery and paranoia and provide a springboard to develop novel approaches to expand our repertoire of interventions for young adults with paranoia.