Understanding paranoia and extreme mistrust, with Daniel Freeman, PhD

For years, paranoia was seen a symptom of severe mental illness only. But in recent decades, some psychologists have begun to think about it differently. Daniel Freeman, PhD, author of “Paranoia: A Journey Into Extreme Mistrust and Anxiety,” discusses his research on the links between paranoia and other forms of mistrust and anxiety; why paranoid thoughts are relatively common; and new research on therapeutic treatments for paranoia. Learn more about your ad choices. Visit megaphone.fm/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

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• 0:31Speaker 01

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• 1:00Kim Mills?

  Is everyone talking about you behind your back? Is your coworker trying to undermine you? Why are you always afraid that something bad is going to happen? For years, paranoia was seen as a symptom of severe mental illness, but in recent decades, some psychologists have begun to think about it differently. They've found that paranoid thoughts are relatively common, that there are links between paranoia and other forms of mistrust and anxiety, and that there are therapeutic treatments that can help. So what are the causes of paranoia? Is paranoia and mistrust more generally becoming more common? Where is the line between a healthy level of skepticism and mistrust and problematic paranoia?

• 1:44Kim Mills?

  What's the link between paranoia and anxiety? Or paranoia and schizophrenia? And what help is available for those suffering from paranoia in its more severe or mild forms? Welcome to Speaking of Psychology, the flagship podcast of the American Psychological Association that examines the links between psychological science and everyday life. I'm Kim Mills.

• 2:10Kim Mills?

  My guest today is Dr. Daniel Freeman, Chair of Psychology at the University of Oxford and a consultant clinical psychologist in the Oxford Health NHS Foundation Trust. He leads the Oxford Cognitive Approaches to Psychosis Research Group and is one of the world's leading experts on paranoia. His book, Paranoia, A Journey into Extreme Mistrust and Anxiety, was published in the UK in 2024. The US edition comes out in March. Dr. Freeman, thank you for joining me today.

• 2:40Speaker 03

  Delighted to be here, Kim.

• 2:42Kim Mills?

  I'd like to start, as we often do on this podcast, with a definition. How do you define paranoia in your work?

• 2:49Speaker 03

  Principally, it's when you think others are trying to harm you in some way when they're not. So it's inaccurate fear that others are deliberately trying to harm you. So you may fear they're trying to cause you psychological harm, to distress you, or financial harm, or even physical harm. And there's a whole spectrum of severity of it in the general population. And it often builds upon what we call ideas of reference when you think others are talking about you behind your back or spreading messages. And it also builds often upon a sort of sense of yourself being a bit vulnerable to harm from other people.

• 3:30Kim Mills?

  How is it diagnosed? I mean, how do we know when it's reached a clinical level?

• 3:34Speaker 03

  So at the severe end, the most common form is what's called a persecutory delusion. And that's when we're very sure in our beliefs about what's going on. So we might be convinced that there are people out there trying to kill us, for example, or take us hostage, or trying to get us out of the neighborhood. That's where we believe it strongly. Also, when we think about it a lot and it causes us distress. I mean, in essence, it's when it causes disruption to life and the disruption typically becomes anxiety and depression and when we're responding to it in a way, when we're typically avoiding things that are important, meaningful in our lives.

• 4:16Kim Mills?

  Now, we all have a little bit of suspicion, I think, at various times in our life. And I'm just wondering how common are paranoid thoughts in the general population? And what about a clinical level of paranoia in the general population?

• 4:31Speaker 03

  We do all have it and it's perfectly natural because all of us have to make a judgment about whether to trust or mistrust other people because there are real dangers out there. So there is an element of risk estimation. Paranoia is where it's become overly weighted to mistrust and to such a strong degree that we're feeling unsafe most of the time. The way I put it is that many people have a few paranoid thoughts, a few people have many. When it's the level of a persecuted delusion, that's often in presentations of severe mental health problems. This often occurs in people who might receive a diagnosis of psychosis such as schizophrenia.

• 5:15Speaker 03

  But there's a large proportion of population who get paranoid thoughts and a large proportion you want help for it, you feel that it's got too much. And what should be very clear is that when there is actual threat out there, when there are real dangers the person's perceiving, that's not paranoia, that's realistic threat perception. Paranoia is where it's just becoming excessive, too much.

• 5:36Kim Mills?

  And do we have any idea the percentage of people with a diagnosable level of paranoia?

• 5:43Speaker 03

  We're in the small percentages for that, so probably around one or two percent. But in terms of the general population, somewhere at least in our, we did a survey of UK adults, about 10,000 a representative sample, and around 16% were saying they would like help to be more trusting of other people. So it arises out of a very important psychological process we all have to think about, about trust. And it's hard sometimes to know where to set the balance. And when we get it consistently wrong, that's paranoia. But, you know, with all this risk judgment, we need to be flexible. It's going to vary where we live, the neighbourhood, time of day, a whole range of factors.

• 6:25Speaker 03

  So it's a process that we probably don't talk about enough with each other. Often we're just following what others around us are doing. But sometimes the people, it's a process that becomes too unbalanced towards the mistrust form.

• 6:38Kim Mills?

  What's the connection between paranoia and other mental illnesses? I mean, for example, I think that a lot of us have an image of people with schizophrenia also almost always being paranoid. Is that the case?

• 6:51Speaker 03

  It's probably the most common sign of psychosis or what's taken as a sign of psychosis. It's one of the most common, but it's raised in most mental health conditions, people with depression. In fact, some of the first historical accounts of paranoia talked about in the context of depression and anxiety disorders, but it cuts across. And certainly, some of the data we have is that for many mental health conditions, when there is also paranoia in the picture, that is often an indication that things might persist a bit longer. And that's mainly because it often corrodes social relationships. And then when they go a little bit wrong, that's not good for psychological health in general. So it's certainly at the severe end, most commonly seen in severe mental health conditions such as schizophrenia,

• 7:36Speaker 03

  but you can also see it in presentations of PTSD and depression, anxiety. And a lot of my work, actually, when I came to it back in the 1990s, it was only thought really to occur with people with psychosis. And you know, one of the first people I met, it fitted so much with just having a very bad experience as people who treated them very badly. And there were so many overlaps with presentations of anxiety disorders that it really started to make me think, actually, this is much more understandable than used to be thought. But also, there's so many connections to other mental health conditions. And then my career has gone on, you know, and when you look for it much more in the general population, it's there at rather high amounts because it arises out of processes

• 8:20Speaker 03

  that were all judgments that we already have to make. So, um, once you actually assess for it in the population, it's present.

• 8:27Kim Mills?

  What do we know at this point about the causes of paranoia? Is it something that is driven by life experiences? Is there a genetic component to it? Is it a combination of those things?

• 8:38Speaker 03

  We've made huge leaps, I think, in understanding the causes of it. At the broad level, you talked about the data we have is about half of it might be down to genes, at least across the population, half of the difference is down to genes, half down to the environment. But at the psychological level, we know a lot. There are multiple factors that are tilting the balance towards mistrust. It may be because people have done bad things to you, so it's unsurprising, you're going to be extremely wary of other people. Sometimes actually people are worried about things they've done in the past. Sometimes it's pushed further along mistrust because of people spending a lot of time worrying, rather engaging in activities. Self-esteem may be low.

• 9:20Speaker 03

  People may be having images of their head of what people are doing to them. There may be discrimination to people that is partly driving this. For some people, they may be hearing voices that are telling them they're under threat. I could keep on going for quite a while. There's loads of things that can push people along, including some substances like cannabis, for example. There are many different factors. And in essence, the more that you have of these, the more likely it's going to push you further along the severity of the paranoia spectrum.

• 9:52Kim Mills?

  Now, you've developed a treatment for paranoia and extreme mistrust that you call the Feeling Safe Programme. Can you tell our listeners about that programme and how it works?

• 10:01Speaker 03

  Yeah, so when I first trained as a clinical psychologist, my ambition was always to produce a much better psychological treatment for these conditions. And it used to be thought that you shouldn't talk about these experiences, people, and that they were not really psychologically understandable. And then we had real progress in some early forms of cognitive behaviour therapy, showed that it is safe and can help reduce paranoia. And then for me, it's about, well, what are the best psychological techniques to do this? At the broadest level, what you need to do to counter the feelings of mistrust and the people feeling unsafe is to help people learn that actually, at least now, that they are safe. And the best way to do that is to build up direct experience of that.

• 10:43Speaker 03

  So helping people go back into situations they feel unsafe in and actually learn that they are okay. But it's harder than that because there's a whole range of other things that are pulling the person to paranoia. I've listed some of them. So even if you go into a situation that is safe, if you're in your mind as catastrophizing and worrying and feeling about how maybe you're inferior to others or vulnerable, you're not going to learn safety. So there's a whole range of other things we need to do to get the person in the right psychological state to experience the world anew and feel safe. So we help people worry less, we help people sleep better, we build up people's self-confidence. Then we've got the person to the best psychological state, we then do this direct learning of

• 11:26Speaker 03

  safety in the world. And that builds up a much more dominant view of the world as safe. And one of the important things to note in this approach is that what we don't really do in our treatment is go in telling the person they're wrong or challenging their existing position. We're setting out an alternative description of what may be going on. And then we challenge that and let's see whether that's right. And we help the person through direct experience. So we try and do less sitting in a room talking, much more, well, let's go to the cafe or walk down the street or give you chances to find out directly how the world is now. And of course, some of our people, you know, the past was difficult. And of course, we don't know what went on then, but we can find out

• 12:08Speaker 03

  how things are now. So let's call it, say if we do it over six months, it's a sort of face-to-face therapy, but we've recently developed and are currently testing a guided online program that puts all of this into an online program. And there's also weekly contacts with a mental health professional trained in this approach too. So we're trying to find ways to scale this approach because our outcomes are really good and are what I hoped for when I kind of set out on this journey to develop it. So it's a treatment based upon a really good understanding of paranoia. And that's important because you need to understand the person's position. These thoughts haven't come out of nowhere. The people have thought long and hard to form these beliefs and we need to understand

• 12:50Speaker 03

  their perspective, but also set out an alternative counter ways or counterweights that set out a journey they could try to see whether actually that might give a different view of the world for them now.

• 13:02Kim Mills?

  Is drug therapy generally associated with this kind of treatment?

• 13:07Speaker 03

  Yeah, so most people I work with are people who are diagnosed with things like schizophrenia, and they all typically be on antipsychotic medication. And my team is normally seeing people who haven't fully responded to standard treatments. So the medication either hasn't worked enough, or perhaps hasn't worked for that person. There's certainly evidence that medications can help, but antipsychotics are certainly people psychosis are really the main line of treatments provided. But there is good evidence that adding psychological therapy helps. And the former psychological therapy feeling safe that we developed looks to be really good at helping a lot of people. So we often can get recovery in persecuted illusions with our psychological treatment.

• 13:53Speaker 03

  Having said that, there's still a proportion of people who don't benefit from what we do. So there have been huge advances in understanding psychologically paranoia. And that's led to better treatments, but there's still much more to learn about it. And there's still improvements we can do in the treatments.

• 14:07Kim Mills?

  You've been using virtual reality in your treatment program for for quite a few years. How does that work? Why is it such a useful tool for treating paranoia?

• 14:17Speaker 03

  Yeah, I first used it, it was about 25 years ago. And that's because there's a real issue in paranoia, which really sort of touched upon at the beginning in a sense, is that there are real dangers in the world. And sometimes you don't know whether someone's being paranoid or telling you about genuine threat in the environment. And it's important that we don't close our ears to the fact that some of our patients may be getting also some hostile behavior from other people. So I use virtual reality to as an assessment tool, first of all, to present people with neutral social situations with computer characters that are programmed to be neutral. And then we knew that people were seeing hostility from these characters. That was genuine paranoia. So firstly, I use it to assess paranoia and then use it to also work on the understanding that underpins the treatment.

• 15:02Speaker 03

  But increasingly, what we've done is use virtual reality to present a whole range of social situations for the person to learn safety in those situations. And of course, you might say, well, they know it's not a real situation. So doesn't that actually mean they don't learn anything? But that's the beauty of VR. Your, your, your body and your mind basically acts if it's real, real, even if your consciousness is telling you that actually it's not a real situation. So if actually you learn that virtual characters are safe, that learning transfers into the real world. And we certainly got evidence that if, that if you, if you try these sorts of practices in VR, you can get real changes in paranoia in day to day life. And in some ways, it's, it's easier for people to tolerate the VR treatment because of this awareness, it's not real.

• 15:47Speaker 03

  Actually gives you enough psychological safety for the brain to take in new information. So that's been a very intriguing strand of our work. And one thing we rather like our online program is a potential that you automate treatment provision within VR. And of course, in VR, you can present stimuli in ways that you can't in the real world that could be therapeutically helpful. So yeah, that's been both a way to assess, but also understand, but also treat paranoia.

• 16:15Speaker 00

  This episode is brought to you by Indeed. You're ready to level up your business, but the pressure to find the right person to make that happen is intense. Indeed sponsored jobs can help carry the load. It boosts your job post to help it reach quality talent fast. Cut through the chaos with Indeed sponsored jobs. Get a $75 sponsored job credit at indeed.com/podcast. Terms and conditions apply. Hiring now? Then this is a job for Indeed sponsored jobs.

• 16:46Speaker 04

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• 17:15Kim Mills?

  What might a typical VR scenario look like? If I were trying to imagine putting on the headset, what would I be seeing?

• 17:22Speaker 03

  Yeah, so the most obvious things that we would do might put people into, not getting onto a bus, going into a shop, being in a shopping centre, or also practising walking out the front door, because some of our patients, even getting out of the street is difficult. And there'll be different levels of difficulty. So initially, there may be no people in these scenarios, and sometimes we're introduced to a few people, a great number of people, and perhaps in these scenarios, the person has to do something where they almost turn their back on people to make themselves a bit more vulnerable in front of the virtual characters. Or we set up some games within it where, for example, in a café scene, suddenly a child will be blowing sort of bubbles and you have to go and catch them, which means you have to get very near people, and everyone then turns and looks at you.

• 18:03Speaker 03

  So you're really the centre of attention. So there are very simple ways to enable people to be in a social setting, to be at the centre of the social settings, that all eyes are on them, and to learn that they're okay, they can cope and they're safe. So that's one direct way, but we're also looking at other ways to use VR to help people build up their self-confidence, so they then feel less vulnerable, for example. So there's a whole range of those other sorts of factors. I've mentioned paranoia, that potentially you could use VR to help provide all these sort of counterweights to the more mistrustful way of viewing the world.

• 18:38Kim Mills?

  Is there a particular point in the lifespan when paranoia begins to manifest itself? And I'm asking this because I'm thinking about parents who might be listening to this and thinking, wow, I mean, is there something I should be looking for in my kids? Or does paranoia really not manifest until adulthood?

• 18:56Speaker 03

  I think there's an awareness, this and a decision-making process, I think, in the early teens, really, when people are becoming more independent and more aware of threats in the world. And I think that's developmentally appropriate. That's when you're beginning to think about what's safe, what isn't, and you're probably experiencing some bad behaviours from your peers and around you, and there might be bullying and stuff. So actually, there is a normal process of weighing it up. And during that, of course, sometimes people may get a little bit more mistrustful. I mean, you wouldn't want to pathologise it at this point. I think it's a normal process. And it comes out, as exactly said at the beginning, it's something that one does have to pay attention to, because there are real threats in the world, and you've got to find the right balance. And those are typically happening from our research when people are reaching a little

• 19:40Speaker 03

  bit more independence in their world. So it actually arises early and paranoia actually is at its highest levels in adolescence and early adulthood. It actually comes down over time. And then perhaps there's a little bit more of an increase later on when people are quite a bit older. And sometimes that may be related to certainly things like dementia, there's going to be a little bit more paranoia. And actually, sometimes when people have hearing loss, that can raise mistrust as well.

• 20:04Kim Mills?

  Does using marijuana or other drugs put people at higher risk for paranoid thoughts? How does substance use interact with paranoia?

• 20:14Speaker 03

  With acute intoxication of some illicit drugs, paranoia goes up and people will tell you that that's pretty clear. And for a smaller percentage of people, that may continue for a bit longer after the drug has actually left the bloodstream. It is more likely to cause problems the more you take and the earlier the age of exposure to it. So that increases the risk that actually leads to a severe or more persisting problem outside the acute intoxication of the drug. And of course, it depends what the substance is and how strong it is. So there's a clear link, but also clearly it's not enough on its own because lots of people take these sorts of substances and don't get these consequences, but it's going to raise the risk. That's clear. It's true for cannabis, certainly, but also I

• 20:56Speaker 03

  think there's connection with alcohol use as well, and that's going to raise the risk. But again, of course, lots of people are consuming alcohol without these consequences. The cause of paranoia is a multiple things coming together that can vary in individual case, but these things do raise the risk.

• 21:13Kim Mills?

  Did the COVID pandemic have an impact on the prevalence of paranoia? I mean, for a while there, we were all afraid of everything.

• 21:21Speaker 03

  Yes, I mean, I don't have good data to this. And it's always hard at the historical level because you don't have the sort of the nationally representative samples that are done over time. I mean, I think clearly for a period, anxiety went up. I mean, what was clear, I think, is that conspiracy beliefs from more general and mistrustful view of the world went mainstream at those times for lots of reasons. I've seen a lot of To oneself and on the internet, everyday life had been transformed at that time. So I think at that time, it's certainly one of the indicators, at least to me, a lot of conspiracy stuff went mainstream. Conspiracy beliefs are different from paranoia. There's obviously an overlap with general form of mistrust. In paranoia, you believe you're targeted and pretty much you're the only one. Conspiracy beliefs,

• 22:05Speaker 03

  that's not the case. It's a belief about some effect to a large number of people. So they share some causes, but there's also differences in those two. So at an individual level for patients, say with psychosis, I met, I think the pandemic at the time had different effects for different people. For some people, actually, when they're outside, there was more space from other people because you had to distance and the world became a little easier to navigate. For some people, that probably did ramp up fears a bit.

• 22:32Kim Mills?

  What is the relationship between paranoia and physical illness?

• 22:37Speaker 03

  There's some overlap and certainly for patients I see with psychosis, if the withdrawal and the isolation is bad for your physical health. And also there's some conditions and pain, for example, it's going to affect your sleep, it's going to affect your mood, it's going to link to mistrust. So again, it can contribute to make things worse. And then, of course, there are, as I mentioned before, things like dementia later that also is likely to bring on mistrust too.

• 23:06Kim Mills?

  What got you interested in studying this aspect of mental illness? I mean, I think you alluded earlier to the fact that it was really seen as something that wasn't treatable years ago, and now it is partly through the work that you're doing. But what was so intriguing to you about this particular issue?

• 23:23Speaker 03

  Yeah, so I remember at university, we talked about psychosis and these sorts of problems and the traditional view that actually there wasn't much psychology to it, it was ununderstandable. That was the dominant view and the psychological treatments weren't, they weren't recommended at that point. And for me, I remember very vividly just meeting the first patient diagnosed with psychosis. And it had to be a home visit because they wouldn't come out of their house because they're worried about governments of various agencies who are going to kidnap them and torture them. And it had to be a home And also, I was told, don't knock on the door, they won't answer. I had to go through to side window, tap on that three times. And Robert let me in and we talked for an hour and, you know, it was so clear on the basis of things that happened to him in his past,

• 24:08Speaker 03

  why he would be so wary of other people. He'd become basically agoraphobic, had left the house. So in fact, you know, although he was fearing all these bad things, he was never really being outside to find out that she, he was going to be okay. And I could see so many connections with anxiety that for me, the route in was at least initially to view this as having a very large contribution anxiety. He was very fearful of the world. He had a very strong, what we call a threat belief, which is typical of anxiety disorders. He was worrying, he was anticipating harm. And he was putting up with defenses so that actually he was protecting his fears. So for me, it was the route in, the first research I did.

• 24:49Speaker 03

  Actually, the first research I did was I measured levels of worry in people with severe paranoia and found they were very high. And that sounds unsurprising, but actually that was the first time anyone had measured levels of worry in people with psychosis, because it was thought that worry was a problem of anxiety and depression. Psychosis is something completely different. So people even didn't even measure levels of worry in our patients. But of course, if you, if you do have worry and you have some fears, this is going to make everything worse. It elaborates the content, it brings images to mind, makes it, you know, play on your mind all the time. So worry was one. Another one I'd done a lot of research on around, which I didn't even mention yet, is that poor sleep. And again, it was ignored in our clients. Everyone was kind of aware our patients didn't sleep very well. It was just thought, well, that's the consequence of it all.

• 25:31Speaker 03

  But actually, and again, it's not really surprising, if you sleep badly, it makes you anxious, it makes you more miserable and affects your judgments of the world. So do a lot of work now treating sleep problems in people with psychosis. We can definitely treat the sleep problems and that brings down the heat of the situations, lessens the paranoia to a degree. It's not the only thing, just like worry isn't the only thing, but you could do a whole range of things to calm the temperature down a little bit and enable the person to then think anew and then find out anew how the world is now.

• 26:02Kim Mills?

  For people who might be on the borderline where they're anxious and they worry a lot and maybe they're in danger of falling into a level of early paranoia, what can they do to prevent it? Are there any sort of mental exercises, things that you would recommend that people could do to ward off and maybe to stop the rumination that makes everything worse?

• 26:23Speaker 03

  Yeah, I think there's some, at least cut across most mental health conditions really, I think it's pay attention to sleep. It is about reducing worry and it probably is building up self-confidence. Those are three big ones. The worry stuff really, I mean, I very understand people worry when they feel frightened because they feel worry protects people, keeps them safe. And really actually worry just skews the worldview and it's much better to limit that time worry, perhaps using problem solving. But most importantly, and again, this is crucial, just making sure you're doing meaningful activity, that you have less time on your own ruminating because that's not good for any of us. So if you can, try and share your ideas with someone you trust, so you're allowed to speak them aloud rather than having to

• 27:08Speaker 03

  turn them over in your head all the time, or just write them down, just to get them, stopping for them and sort of rolling around in your mind and spending too much time on them. Get engaged meaningful activity, try and get good sleep. Also, just try and actually go back to all the good qualities we have and make sure we're putting them in action. So, I mean, and I think those things are good across mental health conditions really. Try not to spend too much time in your thoughts, certainly not in the night time in the early hours, which often we all do, but that's just not a good way to solve things. If you really want to worry, fine, but just keep it to a much smaller portion of your day. Problem solving is better and what's even better is actually really being engaged in stuff that is meaningful and purposeful for you.

• 27:49Kim Mills?

  For people who have a clinical level of paranoia, is there any self-awareness that maybe what they're thinking is unrealistic? I mean, is there some way of getting people to understand that, know everybody is not looking at you, the world is not out to get you?

• 28:05Speaker 03

  Yes, I mean, I think clinically it varies. So for some people, what we call the degree of conviction in their beliefs, how strongly they believe it. We might say, how strong do you believe it? Not 100%, 0% I don't believe it, 100% I believe it absolutely. Some of patients, it might be around 50 or 60%, but go up at particular moments. But some patients will say, I believe 1,000%. And we can certainly get really good outcomes of the treatment, even if people have no awareness. But plenty of people do have an awareness, even at the highest standard, it's dominating their lives too much, that this is taking up too much headspace. And the way in for our treatment is really sometimes just recognizing this is tough. It's taking up all your headspace. You're not thinking about all those other things you'd like to be doing in life, and it's making you anxious, and you're not sleeping so well. So maybe we can work on that a little bit.

• 28:51Speaker 03

  And then as we work with people, we might then do exercises, you know, is it better to stay in your room worrying? Let's try that for a few hours or go out for a walk. So we test that out and see which is better. And while we're not making a big song and dance about at that stage, the person on the walk might go, actually, that was quite nice, that walk. And I saw some people and it was okay. So you're allowing the person to have some experiences a bit more positive. And later on, we'll, we'll, we do make that very clear. We're looking at signs of safety and we're trying to work out where the safety is in the world now. But there's lots, lots, lots of things we could do. But clearly, for some people, there are difficulties engaging with help, and that's hard for the person, but also hard for the, for the, for the people around them who would like them to talk to someone and get help. And that, that really can be difficult.

• 29:37Speaker 03

  But for us, generally, it would be less saying, going, get help for your paranoia, because that may not go down so well as that as a label. And often the words we're using are worries about other people. But we might be saying, well, these are having effects on, on the things you do, on your mood, relationships. So maybe that's worth checking in with someone about.

• 29:57Kim Mills?

  So what are you working on now? What are the big questions you're still trying to answer?

• 30:00Speaker 03

  Oh, lots of things, lots of things. We're doing a very large study treating sleep problems in patients with sleep imital problems. This idea that we can improve sleep a lot, that's great in itself, but also that will lessen problems like paranoia. We're doing another large clinical trial testing Feeling Safer, which is our guided online program, which is basically putting our really good face-to-face therapy into guided form online. So that's about accessibility. We're doing some VR work, treating low self-esteem in people with psychosis. Basically, my team does a lot of work. We do a lot of work trying to develop the understanding of problems like paranoia, using that knowledge to develop better treatments and then trialing it, and then also work around

• 30:44Speaker 03

  getting it out there into services. Some of that is in training, or some of it is in models of delivery that actually perhaps rely less on a therapist, but more on the person having more control. One is always learning. You know, we're evolving people with, who've had or have severe paranoia in our research, and they contribute a lot to working out what's important to research and how to do it. So we have a lot of lived experience advisors that improve the quality of our work and the purpose of it. So we're focused really on trying to develop really good psychological therapies and get them out there. And there's lots of work to be done on that.

• 31:20Kim Mills?

  Dr. Freeman, I want to thank you for joining me today. This has been really interesting. You can find previous episodes of Speaking of Psychology on our website at speakingofpsychology.org, or on Apple, Spotify, YouTube, or wherever you get your podcasts. And if you like what you've heard, please subscribe and leave us a review. For those of you who want to know more about psychology and the work of the American Psychological Association, you can join us as a supporter. You don't have to be a psychologist. The benefits include a subscription to our award-winning magazine, Monitor on Psychology, as well as discounts on books and other publications. So if psychology is your passion, or if you just want to know more about the science, you can become a supporter by visiting at.apa.org/speaking.

• 32:02Kim Mills?

  That's at.apa.org/speaking. If you have comments or ideas for future podcasts, you can email us at [email protected]. Speaking of Psychology is produced by Lee Weinerman. Thank you for listening. The American Psychological Association. I'm Kim Mills.

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