Delusions are complex and difficult-to-define features of psychosis. They are central to schizophrenia but also occur across a range of psychiatric conditions and, to a lesser extent, in the general population. Research shows a strong association between trauma and delusions, including exposure to childhood abuse and bullying, yet the mechanisms connecting early adversity to delusion formation remain poorly understood. Negative beliefs, emotional dysregulations, post-traumatic stress disorder (PTSD), and dissociative symptoms may play key roles in this process. These gaps limit the development of effective treatment and prevention strategies. While most existing evidence depends on narrative, deficit-based, phenomenological, and quantitative approaches offer valuable insights into lived experience, context, and emotional processes. A recent study published in The Lancet Psychiatry used a multi-method and qualitative design that integrated narrative interviews and phenomenological checklists. The aim of the study was to understand how sociocultural context shapes self-experience and trauma-related delusions in individuals with first-episode psychosis.
Participants were recruited from three National Health Service (NHS) early intervention in psychosis (EIP) teams in the UK using purposive sampling. All participants had past or current clinically significant delusions and continued to receive standard NHS care. Eligible participants were aged 18-65 years, and the presence of delusions was confirmed by psychiatrists using positive and negative syndrome scale (PANSS) criteria. Data were collected from standardized psychiatric measures, in-depth narrative life story reviews, and phenomenological examination of anomalous world experience [EAWE] interview, as well as clinical records. Data were analyzed using a qualitative multi-method approach, integrating all three frameworks through parallel analyses, meta-inference, and descriptive statistics.
A total of ten adults (median age = 24.5 years [interquartile range = 14.8], male = 3, female = 6, non-binary = 1, White-Black Caribbean = 2, White = 8) experiencing delusions and first-episode psychosis were interviewed from Jan 4, 2023, to June 14, 2023. The most common delusion themes were religious (9/10), persecutory (10/10), and referential (9/10), with no theme occurring alone. Phenomenological analysis demonstrated a global alteration in lived-world experience, with the EAWE score ranging from 1 to 48 (mean = 26.5±10.85).
The first narrative theme emphasized early and repeated negative interpersonal emotions, particularly shame, followed by experiential avoidance, which shaped the embodied development of delusions. This process included: major upheavals preceding delusion onset; and recurrent anger, shame, fear, and perceived loss of control. The second narrative theme identified three patterns of emotional transformation: “being under the spotlight,” shifting from shame to invincibility; “being part of something bigger,” moving from emptiness to embodied love, hope, and awe; and “being in a simulation,” associated with disembodiment and social disconnection.
This exploratory, idiographic study has limited generalizability. The sample was small, predominantly White, and largely female, and participation required a high level of verbal ability. Reliance on verbal accounts may overlook non-verbal experience. Future research should incorporate creative and inclusive methods to broaden participation and capture more diverse forms of lived experiences.
Overall, delusions emerged through temporally extended, embodied, and cognitive-linguistic processes that transformed the experience of self and world as a unified experience. Metonymic thinking rooted in bodily experience helped explain extreme appraisals, such as feelings of being evil or divinely connected. These findings suggest that intervention and prevention strategies for psychosis should prioritize emotional and embodied contexts as key therapeutic targets.
Reference: Ritunnano R, Littlemore J, Nelson B, Humpston CS, Broome MR. Delusion as embodied emotion: a qualitatively driven, multimethod study of first-episode psychosis in the UK. The Lancet Psychiatry. 2026. Delusion as embodied emotion: a qualitatively driven, multimethod study of first-episode psychosis in the UK
