BEHAVIOR THERAPY 34, 97-115, 2003 Anxiety-Based Cognitive-Behavioral Therapy for Paranoid Beliefs FOLLIN ARMFIELD KEY MICHELLE G. CRASKE ROCHELLE M, RENO University of California, Los Angeles Seven patients with chronic paranoid schizophrenia or schizoaffective disorder, in remission from substance dependence, received 8 sessions of cognitive-behavioral treatment (CBT) aimed at reducing their conviction in paranoid beliefs and associ- ated anxiety (both measured on a 0% to 100% scale). Treatment was modeled on es- tablished CBT treatments for anxiety and included psychoeducation, relaxation training, and cognitive restructuring. Starting with neutral situations and gradually addressing paranoid situations, participants were taught to generate and evaluate al- ternative explanations for events. Participants were assigned diagnoses using the SCID-IV. They were assessed at baseline, posttreatment, and 1-month follow-up using interview, self-report, and cognitive measures. A multiple-baseline-across- subjects design was used. Results indicated clinically significant improvement by 3, mixed results for 1, and no change for 3. The belief that one is being harassed, persecuted, attacked, cheated, or con- spired against falls on a continuum ranging from paranoid ideation to perse- cutory delusions (DSM-IV; American Psychiatric Association, 1994). Such beliefs are features of many disorders, including schizophrenia. Clinically, paranoid beliefs bear some similarities to anxiety. Both involve excessive vigilance for danger, misinteqoretation of threat where other people do not see it, and attentional and memory biases for threat-related material (Bentall & Kaney, 1989; Cameron, 1959; Fear, Sharp, & Healy, 1996; Mathews & MacLeod, 1985). Behaviorally, both involve some type of avoidance (Freeman We would like to acknowledge Bruce Baker, German Cheung, Haidee Cuasim, Cara Garden- schwartz, Holly Hazlett-Stevens, Christopher Heckert, Sarah Hockman, Eric Holman, Janice Jones, Julie Lery, Stephen Lonseth, James Macion, Jason Machan, Jayson Mystowski, Jose- phine Shih, Joseph Ventura, and Bonnie Zucker. A very special thanks to Robert P. Liberman. This paper is based on a doctoral dissertation. Address correspondence to Follin Key, Ph.D., Kaiser Permanente, Psychiatry Department, 1150 Veterans Blvd., Redwood City, CA 94063; e-mail: keyfollin@yahoo.com. 97 005-7894/03;00974) 11551.00/0 Copyright 2003 by Association for Advancement of Behavior Therapy AlI rights for reproductionin any formreserved.