Dr. Jane Gilmour: Hello there and welcome to Mind the Kids. I'm Dr. Jane Gilmour, honorary consultant clinical psychologist and child development program director at UCL. Prof Umar Toseeb: I’m Uma Toseeb a professor with a focus on child and adolescent mental health and special educational needs. In each episode of Mind the Kids, we select a topic from the research literature and in conversation with invited authors, sift through the data, dilemmas and debates to leave you with our takeaways for academics and practitioners. Dr. Jane Gilmour: This episode asks, anxiety and paranoia, what lies beneath? Prof Umar Toseeb: I have to be completely honest and confess here. I know very little about paranoia, especially in the context of the research and the adolescent research literature. So this is going to be very interesting conversation. And I think that what I have learned has been from Jess's paper. So it's been really, really good. What are your thoughts so far, Jane? Dr. Jane Gilmour: So, my, I mean, my point on not knowing very much about a topic means these exploratory questions often bring to life themes that everybody's interested in or look at something from a different angle. So I would never apologize for not knowing. I think curiosity drives the world. But yes, this idea about anxiety and paranoia are fundamental to the paper. So the idea of paranoia describing a belief or misinterpretation of information, that's usually personalised, so a targeted intentional harm. Whereas anxiety, including social anxiety, would be a disproportionate worry that a negative event might occur, but it's not personalised. Those two strands, which is something that Jess is pulling apart in her paper, are separate concepts, if you like, and the exploration about whether they coexist or are separate is one of the key themes of the paper. Prof Umar Toseeb: Yeah, and from my reading of the paper, I think that the argument that Jess makes in the paper is that often or previously or in adult populations, paranoia might have been thought as a part of mental illness. And part of the work here is to think about how we conceptualize paranoia and whether it can be thought of as part of a social anxiety framework. Dr. Jane Gilmour: And I think, I mean, certainly aspects of paranoia can be included in a psychosis diagnosis, but there is a strange divide, if you like. And I think it's Daniel Freeman who's worked out, he's written a lot about this, about the divide in the social between neurosis. So that might include social anxiety and psychosis, which could include paranoia in its most severe form. So a delusion, but we also know that there's a quite high proportion of typical population that have paranoid thoughts, about 15%, which suggests that there's something useful, perhaps adaptive in having a paranoid thought. And that's an interesting concept that I think is a fairly new idea. So traditionally paranoia has seen being seen as a negative and now it's being more understood as a normal aspect of a framework or a typical, typical framework, shall we say. Prof Umar Toseeb: I think that some of the work that I've done on what we call common mental health conditions like depression and anxiety, we try and frame that as symptoms or characteristics or feelings, behaviors that exist on a normal continuum, normal distribution, and they exist in the population and it's the severity that differs in people with diagnosable mental health conditions. But I would never, well, I wouldn't necessarily have described symptoms of like paranoia to be part of what the general population experiences. But actually, like you've just said, it's not that uncommon. Dr. Jane Gilmour: I think we’ve started to ask the question and I think that really, and I think that Jess's paper really highlights that too, which is one of the reasons I'm so interested to think about it. I'm also, you know, keen to think about the idea of this developmental lens and I think this is so important and many of us, I hope, who are developing research questions and writing research grants will be thinking about looking again at the adult psychiatric literature with this developmental lens. So the idea that the adolescent or the young adult population may have a different experience or may hold keys to the development of a difficult outcome or mental health disorder. So it's really interesting. It's really, it's really inspirational. There's a lot to ask here. I wonder if we should get going and ask Jess some of our questions. Some of them I think she'll be able to help us with. And I think some remain unknown and that's the best sort of situation. There's always more to do. Prof Umar Toseeb: So let's do it. So we're joined by Dr. Jessica Kingston from the Department of Psychology, Royal Holloway University of London. Jess is the lead author of the paper Social Anxiety and Paranoid Beliefs in Adolescence, published in JCPP Advances. Welcome, Jess. Dr. Jessica Kingston: Hi, thank you so much for having me join you. Prof Umar Toseeb: Thank you. Let's start with some background. So how did you get into this line of research? Dr. Jessica Kingston: That's an interesting question. So I trained as a clinical psychologist, what feels like quite a time ago now. And during my training, I worked in an adolescent and child inpatient unit and then subsequently joined there as staff after training before taking on an academic job. And then working with adolescents more generally, I think that you know, it's such an important time for developing relationships outside of the home and starting to develop this ability really to be able to discriminate around when you can trust and when you can't trust. And I think being able to develop those relationships and to be able to have a sense of being able to trust others is so integral to relationships and to mental health generally. So not just about psychosis or a particular mental health outcome, but actually mental health in general and mental wellbeing. And that's certainly what some of our research suggests too. So I think during adolescence, it's that period where it's so important to young people, whether they belong or not, and as they start to experiment with identity and developing their self-esteem. So for me, I think it's a critical age where both these fears are likely, or for some are likely to manifest. And if you think about those cycles that can become established, it's that scope of opportunity to make a difference, to try and offset those vicious cycles that can become established. Sorry, yeah, go on. Prof Umar Toseeb: So the paper is based on two kind of constructs, so paranoia and social anxiety. So just for people listening, what do those two things mean? As in what are those constructs? How do you define them? And then what do they look like for adolescents? So like what kind of paranoid thoughts do adolescents have and what kind of social anxieties do adolescents have?

Dr. Jessica Kingston: Yeah, so paranoia is the fear that other people want to cause you harm and social anxiety is almost that fear of being humiliated or doing something that will kind of show you up and so there's like thematically they're both quite similar because there's that real kind of social element to both of them and they've got lots of kind of common factors that feed into them but like the key difference is for paranoia the feared object is someone else. So it's that someone else wants to cause me harm or is planning to harm me. And for social anxiety, it's more about I might do something that will show me up in front of other people so they judge me badly. So it's almost like that focus of attention is slightly different between the two, but they've got lots of commonalities. And I think that's kind of why it's theoretically interesting. So we see that, you know, in adults, we see that these things co-occur a lot. And we know with social anxiety that this kind of starts in adolescence. So I guess some of our kind of key questions when we think about adolescent development of paranoia is that how does it fit with social anxiety and what are the differences and why might they go off in different directions? Dr. Jane Gilmour: And you highlight the developmental issue so well that this adolescent phase of brain development is so fundamentally social in its character. The idea of integrating into a peer group is one of the key drives of the teen brain. And also the heightened emotions and the ideas of self-evaluation are really key. So there's so much that's sort of primed and ready for social anxiety and or paranoia and those ideas of reference I think you describe in your paper, know, so ideas of reference would be, you know, making it all about you. So as a teenager, everyone's looking at my bad outfit. That could be described as an idea of reference, couldn't it? But that's also something typically that a teenager might think because they are developing themselves in reference to other people. Prof Umar Toseeb: When we're thinking about some of these paranoid thoughts and social anxieties, I always try and understand to what extent, when does normal become abnormal, if we can call it that, or something of clinical concern. So, you know, like you say, and like Jane said earlier, paranoia and social anxiety are just quite common, I think, in adolescence. But when does it become problematic? Dr. Jessica Kingston: You know, for me, these are some of the most interesting questions when we think about this stage of development, because my hunch is that for young people, like you say, there's much more variance that's normal. So I think with adults, this is my hunch. And I think really these are empirical questions, but that there's less variance on the whole. But in adolescent development, that we should expect some elevators, a normal elevation of the worries that we see in adults in the sense that it's not necessarily at a problematic level. But I guess there are then key indicators that will help us to make that difference. And I guess before I go on to those, I think the other thing that is really interesting is that for adolescents, the world they live in, the social world includes some of this kind of lived experience of bullying, people being really unkind to each other, gossiping about each other in a way that's attenuated typically when you get older. So that just making that difference in the distinction between what's actually a young person who's living in a social environment that's really problematic and what we need to change is like school policies towards bullying, for example, versus what is an exaggerated fear of harm. So it's, you know, when's it become generalized? When's it become excessive to the lived experience? And I think that kind of thing is really hard to distinguish between if we're looking at like self-report questionnaires we really need like interviews. But I guess some of the key things are around like how severe is the belief? So you know how rare and kind of a little bit you know out of kilter with what seems reasonably likely to be things that are happening. So it might be you know what might someone else's perspective be on this fear like what might the teacher's perspective or the parent's perspective be? I guess how distressing it is, is always really important. So if a young person is finding these ideas and worries really distressing, but also frequently distressing, so the level of intensity, but also the frequency of feeling distressed by them. And I guess how much they interfere with daily life really matters. So if they're not going to school or, you know, dropped out of the friendship groups getting a sense of how much it's impacting. And then there's a level of conviction. So can they think about other ways of making sense of their experience? So if they've just got one kind of fixed idea, that's quite a, you know, for example, quite a stressing and severe idea, then we know we're kind of moving much more into the clinical domain, because we can see that actually they're not on their own able to stand back and maybe get a different perspective or come up with a variety of possible ways of making sense of their experience, they kind of jump into that threat belief and then, you know, remaining quite fixed on that threat belief so they can't experiment with other ways of making sense of that experience. Prof Umar Toseeb: I think I understand it conceptually and what you're describing makes sense to me based on my knowledge of... and the severity and the frequency of the symptoms. But I think I'm struggling to like think of a concrete example. like what's, can you give us an example of a paranoid belief that would fit some of that clinical criteria? As in like, can you talk us through like what that might look like? Dr. Jessica Kingston: Yeah, absolutely. So I guess that there are that people are plotting to, you know, severely harm you, want to kill you, or that people might be hiding or stalking you or following you or hiding in the garden or those kind of things. I guess, you know, young people have not completely uncommon, but but I guess we're recently realising that some of our research may be a little bit more common than we would imagine. But worries around being kidnapped or people breaking into the house to kill them. But we're thinking about not like young children. These are children who are like 16, 17, 18. So whereas you might develop mentally see that young people, younger people might not have the perspective to know that's not going to happen. Like if I think of a seven year old, like those worries are quite developmentally appropriate. But as you get older, when you start to develop that capacity to discriminate, you know, what's safe and what's not safe is that there's that hasn't happened so that they still retain some of those quite severe beliefs. Does that give you a flavour? Yeah. Prof Umar Toseeb: Yeah, I think it does. You know, that's very helpful. And I think that now might be a good time just to think about some of the findings from, from your work. And I think part of it was that you looked at how social anxiety and paranoid beliefs co-occur and whether they do. But I think, I mean, the striking thing, but also like, I think the important thing for me is that I think about 60%, I think the statistic was a 59 to 60 % of your sample didn't experience any social anxiety or paranoia as in. So over half of kids don't experience these things. But then there were various combinations of social anxiety with or without paranoia, paranoia with or without social anxiety. Dr. Jessica Kingston: Yeah, that's exactly the case. So basically what we did in the paper was to use some established thresholds when they exist. And then if they didn't, we kind of mirrored the thresholds that do exist and kind of created them. And so we kind of set the bar a little bit higher than others might do in terms of how to define whether people had elevated paranoia. But still we're thinking about continuum, so we're not thinking about, although some will, but most wouldn't be at that level of really severe. It would still be a bit more in the middle of the distribution. But what we found was, as you say, if we just take the kids who were scoring up as elevated, what we found was like in

for social anxiety then 50 % so for all the kids who were scoring up as having elevated levels of social anxiety 50 % of those were also reporting elevated paranoid beliefs and so by creating the categories we were able to then look at I guess what might differentiate the children or teenagers who just have elevated social anxiety versus those who also have elevated paranoia which links back to that idea of a hierarchy where we've got kind of these social fears that are really common and lots of people have them and that those are like the foundation to, for some people, developing more significant worries about other people wanting to harm them. So we can kind of look at what makes the difference or what factors seem to differentiate those groups. Dr. Jane Gilmour: I'm really interested in that. some, you know, there was evidence that some of those young people may be going through that paranoia hierarchy. I think it's Freedman's, it? So you, you there's a, there's from social anxiety, you increase the sort of severity and the ideas of persecution and so on until you may, you know, if you reach the top of that hierarchy, you may have a paranoid delusion. What, but, some of those young people were not going through that hierarchy in as much as they were only paranoid but not socially anxious. So do you think those are a separate group or what do you think is underlying their story or their associations? Dr. Jessica Kingston: Yeah, so that like you say, that group is somewhat not anticipated if we were to be thinking about that kind of hierarchy model. And we've actually like got other sets of data where we find the same percentage. So we've been asking some similar questions to this paper in a bigger data set that's longitudinal data set and using different measures too. So I think that's that's pretty interesting that there is again this group and they're a bit younger and there they've got paranoid worries without social anxieties. And I think it is interesting, know, to want, it's important to want to understand that a bit better. So is it young people who have particular lived experiences of some groups that are causing them harm or have caused them harm in the past, but alongside that they don't have these generalized and kind of socially anxious worries. They also showed that they had, like in terms of their relationships, didn't seem to be so impacted. So it's possible that they have like, you know, networks of support or protective factors that are co-occurring with these, you know, the experiences that have given rise to the paranoid worries. So I guess it makes me think, there groups of children who have particular lived experiences which mean they have developed worries? For other people want to harm them but alongside that they also have experiences with relationships where they do feel supported and protected which offsets that kind of social anxiety but I think really like the key thing for me is it is an empirical question like we don't really know but I think it's important that we are, from memory it was about six percent I think we're in that group and maybe about eight percent in this other data set but it's always important to understand the exceptions as well as the people who seem to follow what we anticipate and those that don't. So I think that's an important avenue for future research. Dr. Jane Gilmour: But what you're hypothesizing is your mental health disorder, if you like, reflects a true reality. So if I'm socially anxious, it's because I have not had a socially positive experience. And if harm has called, you know, I have had experienced harm to my person, I may have, you know, a sense that it's going to happen again. So there is some sense of a sort of validation, if you like, if I understand it is an empirical question, and these are hypotheses. But if that were the case, I mean, it makes complete sense in some ways that our vulnerability might be the lens through which a previous experience becomes more extreme and then becomes a difficulty for us. But that experience has a relevance to the way we're presenting. Dr. Jessica Kingston: Yeah, I mean, without a doubt, think all of the, you know, if we look at the backgrounds of people who have persecutive delusions or paranoia, it always, you know, it would be very unusual that it doesn't come from a lived experience of in some way, another person being perceived as causing us harm, you know, as in a particular event, something that's happened in life or a series of things that have happened. So it always comes from somewhere and it is capturing that exaggerated element of it. And I think, you know, it often makes me think about... minoritised groups, so people who belong to minority groups, and that idea of healthy cultural mistrust. So the idea that actually these, what looks on the face of it like paranoid beliefs, are actually, you know, can be very much in line with lived experience of, you know, their reality of being from a minority group, which I think is just so important that we're always keeping that as part of our hypothesising. Prof Umar Toseeb: I'm thinking about the parents who are listening to this. I went and I did a talk about something a couple of months ago and one of the comments was, well, I'm not surprised you found that because that's what you were measuring. Like you've gone looking for it and you found it. And in this, in the era that we're living in at the moment, there are lots of things that, you know, parents are now worrying about or having to worry about such as bullying, social media, mental health in like the broadest sense, depression, anxiety, self harm, et cetera. And this feels like it could land as, is this something else that I now need to worry about with my child? How much of a problem is this? like, do parents need to be worrying about this? Or is this like, we've talked about it being reasonably common, like paranoid beliefs. But how much do parents need to worry that their child might be experiencing paranoid beliefs to the point at which they are causing impairment? Dr. Jessica Kingston: So I guess I would, you you never want to add to the range of things that parents need to be worried about. And I think for most people it resolves. So even if, you know, we've been talking a bit, haven't we, about that natural developmental spike in particular things. So a natural spike in self-consciousness and social worries. And I think we can think of it, I think, and actually it's very helpful to think of it with that lens, and that there will be a minority of young people for whom those persist and I think that will be apparent. we wouldn't, it would be hugely unusual to have a young person who's troubled by or having difficulties with paranoia, who isn't having other signs of not feeling well. So it would come alongside things like anxiety and depression. So I think if... parents who are listening to this, you know, it would kind of fit a profile. So it would be that they would already be aware that their child or the young people that they spend time with is already struggling with their mental health. It would be very unusual, I think. you know, they would be with... They would be showing other kind of constellations of like a pattern of symptoms for which Paranoia might be one of them. And at the lower level, I guess there is what we're saying is there's this kind of natural fluctuation and for most people it will resolve. So I think you know if you're getting a hunch that you know kids are really withdrawing from friendship groups, not going to school or just about making it to school but not really going to class, you know those might be some signs but I think parents would already be worried about those, they'd already know about those things. Dr. Jane Gilmour: I wonder, and this is a bit of a sort of radical comment, but you know, there may be, it's a little bit like risk taking. So here's my hypothesis. In the past, we used to think about risk taking as an indication that the teenage brain was broken, that they hadn't developed the frontal lobe inhibitory capacity. And so they marched around the world taking dangerous risks. Actually, with a reframe, it's about exploring the world and learning. And it's a perfect

way to explore the world because it allows adolescents to develop skills and find out something before they become independent. Is there something, and I appreciate this is quite a radical idea, is there something given that it is fairly common in a group that there is something adaptive in it and it's an important part of the adolescent experience to be slightly paranoid in their thinking and slightly socially anxious so that they find their social group? And that all things be equal, that will resolve and in a small proportion, those features don't resolve and they may have ongoing difficulties. Is that too radical, do you think? Dr. Jessica Kingston: No, I think it is adaptive. Yeah, absolutely. Imagine if we didn't have any worries about other people. You know, we send our teenagers out into the world and they're completely oblivious to risk. Yeah, so it is adaptive for all of us. And I think that experimentation is from where you get that. It's the fine tuning, it? It's like by experimenting, you start to learn what the...you know, the boundaries are between trust and mistrust, for example. And the way we learn, if we just told a rule, we don't learn it as well as if we develop it through experience. So just telling someone certain things has less of a... It's not as effective in terms of our learning as by experimenting ourselves and developing our rules through our experience. So I think it is, you know, it's very important. And alongside that, then...talking as best we can to teenagers about their experiences and helping them to make those discriminations. So if kids can come to us and like talk through something, we can then give some feedback on, know, like parents might have a sense of, or, you know, I might be bit more cautious about that or, you know, so you can kind of be the moderator, but I think absolutely, you know, it has a healthy function and it's important that kids do that. Prof Umar Toseeb: I think it's a final question before we wrap up about, as you were speaking, I was thinking about when we do A-level psychology even like very early on, one of the things that we learn about is socially responsible research, as in like we do research for the benefit of society and when it's appropriate and when it's not. And I wonder whether... So, and also one of the, one of the criticism, one of the criticisms of the, the, narrative that there are the narrative and probably the reality that mental health difficulties are on the rise is that mental health literacy has got to a point where, more people are recognize learning about what the symptoms are and recognizing them and then reporting them. is there a risk that this might happen with paranoia as in the more we talk about it, then it becomes part of people's vocabulary and becomes part of people's experiences and things that they might not have noticed previously or might not have reported previously then become a problem. I don't know. Is that a fair question? I'm sorry. It just occurred to me. was like, because yeah, what do you think? Dr. Jessica Kingston: That is an interesting question. I totally agree with you in terms of like the role of so much information about mental health being accessible to young people and this idea of kind of like self diagnosis and you know in that kids or young people, probably all of us actually, I don't think necessarily we need to differentiate young people but I guess they don't have so much lived experience but that by making lots of information available, there's that risk that people will start then experiencing those things more or reporting them more. I mean, I guess it wouldn't be fair to then pull out paranoia and say it's in any way different, right? So if it's the case for depression or for other conditions, then of course it would apply to this too. But I think that doesn't take away the fact that if we think about...mental health problems that have been around for a very long time. They start in adolescent psychosis, for example, you know, most people with psychosis would report the development of those experiences during adolescence. So I think the thing for researchers is having the tools that really allow us to distinguish between what is, you know, what is likely to be a clinical problem versus not, and then, you know, not intervening where there doesn't seem to be the need. And also, I guess, just education. So guess one of the things I think is also just important is that people, that we kind of really make that point that these worries come from very understandable places that we, you know, in fact, in many ways, we try and do the opposite. And we're saying this is part of a continuum. We all feel this way at different times and sometimes it will escalate and sometimes it will come back down. And actually it's part of healthy adaptive functioning. And I guess what we really want people to think is actually it's quite normal. Lots of people feel this way at times and we don't need to be worried about it and helping young people to be able to make those distinctions when actually might have escalated to a level which I probably do need some support. So I think there's a big job to do there. Dr. Jane Gilmour: Jess, I think you've hit the nail on the head there. think that's so important about about normalizing these intense emotions for teenagers and young people, because very often a teenager will say, you know, am I mad? Am I you know, is there do I have a problem? What you do have is a strong emotion because it's helping you learn about the world. And that's okay. And if it persists and it gets in the way of day to day functioning, that's something different. So it is about educating the population and I think adults as well. So young young and young adults have access to the diagnoses, as you said, that self-diagnoses phenomenon. But we've also got to help young people think about trying on identities. And I think that also is underpinning some of this as well. But as adults, we have to recognize that difficult moments will happen. And you may have a paranoid thought. And yes, that's something that very often we know from your paper is not something that we would be concerned about in and of itself, in fact it might be indicative of telling us something about your past. that educate, you know, taking an education for young people, but the adults supporting them as well will be so important. So I think it's a really important point to end on. Prof Umar Toseeb: Thank you so much, Jess. That was a really, really interesting conversation. And I think that in my lack of knowledge of the topic, I feel like I've asked some very probing questions and I hope that's been useful for everyone listening, but also for you to try and think about some of those. yeah. Dr. Jessica Kingston: Thanks so much, I loved your questions. Prof Umar Toseeb: I'm so glad that Jess was okay with my questioning. I sometimes, I felt a bit like, I felt like I was challenging her to the point of, what are you doing? But like, it was more from a place of trying to understand the topic of which I didn't have much knowledge. Dr. Jane Gilmour: No, I think these are all good questions and I think I think it always uncovers aspects to a topic that we haven't thought about before. And if you're thinking about the same topic all day, every day, you won't come up with anything new. So I don't think there's anything other than a well intended curiosity. I think that's great. what were you surprised to find you think in the course of our discussion? Prof Umar Toseeb: I think, you know, it was the thinking about paranoia as through the lens of social anxiety, given that it co-occurs so often. and I say this to students in class sometimes around social anxiety, it's good to be socially anxious sometimes. It's an adaptive response. You know, if you're anxious about certain, a certain situation, it depends on the situation, but you know, sometimes it's you should be anxious and I'd be worried if you weren't anxious. And I think that that kind of framing of social anxiety sometimes can be not as negative as you might feel. But I think in my head, previously, paranoia was always a bad thing and it was always associated with serious mental illness. But actually after this discussion and reading this paper, I'm much more, we could view paranoia as part of the normal human experience. again, if we think about it, and I think you made the point really well where there could be an adaptive part, it could be adaptive and there must be a function for paranoia and there must be healthy levels of paranoia as well. And it might also reflect what the young person has previously gone through in their lived experiences. And so, you know, and I think It's toned down the valence of paranoia in terms of how negatively I perceive it. Dr. Jane Gilmour: Yeah, I think brief moments of paranoia probably keep us safe, but otherwise, and I think that's, and that's, that's the difficulty, isn't it? We, know, when we think about these diagnostic labels, they can become the overshadow quite literally the nuance. I mean, I really, I really enjoyed the conversation. I thought there was so much from a clinical point of view that I could learn from this paper. And it really highlighted the idea of asking questions from socially anxious young people to figure out and look a little bit closer at the idea of paranoia. I think Jess's paper had a really good scale for all clinicians who might be wanting to include some assessment on paranoia just routinely. And the revised green paranoid thought scale, which is the one that was used in Jess's paper and it only has 18 items. So it's great. You can slip that into an assessment easily. But what is interesting about using a questionnaire, I often find it really helpful because if I'm assessing, let's say for obsessive compulsive disorder, OCD, producing a list of written questions helps normalize behaviors or thoughts for young people who might otherwise be reticent about speaking up. And I think that's probably very relevant for ideas of paranoid thinking. you know, having a set list of questions to refer to, gives us the idea that there may be others out there who've had similar thoughts. The other thought, and we've talked a little bit about the teenage brain and why it might be prime for paranoia, but the other thing that really made me think about was in terms of intervention. And we know that there's an evidence base for using cognitive behavioral frameworks for social anxiety and paranoid ideas, and in some cases, psychotic conditions with good efficacy and effectiveness think linked to paranoid thoughts and beliefs, a conversation I was having with a friend last weekend was around, I was saying that I always struggle with this, separate your thoughts from you as an individual and just observe them. like, I don't know what that means, like conceptually I get it, but you're asking me to do it and I don't know how to do that. But actually, One of the ways he explained was he was just like, well, sometimes you have really weird intrusive thoughts that don't, they don't define who you are. They just come into your head and you know, that's not who you are. So you just need to see, and you're very able to separate them from you. You're like, no, that's not who I am. Like whatever. And he was like, you just to lean into that and do that more often. And I imagine, I don't know. You tell me, is that how you deal with paranoid thought? Yeah. But it's a really difficult thing to do. And sometimes, you know, when we're doing therapy with quite young children, you know, 10 or 11. But this is true for many adults. So there's a lot of difficulty in separating thoughts or feelings. And when I'm doing CBT with children in the first instance, I draw thought bubble in the shape of a number one, and a heart with a number two alongside it. if you like, so there's a very clear idea from a CBT framework, the thought comes first and the feeling comes second. Now understanding that as part one, but knowing whether it is a thought or a feeling is very difficult. And that's often a large part of the work and understanding that and recognising that in the moment when you are feeling very emotional, for example means, you know, it is a challenge, but it is part of the framework and it's definitely a teachable skill. So I think if you were struggling with the idea, you're definitely not alone. And even I dare say there's many, many a therapist who has similar, oh, is that, am I think, do I feel that or is that a thought? And it's very difficult to pull them apart, particularly in the moment. Prof Umar Toseeb: What's your takeaway? Dr. Jane Gilmour: So I think there two takeaways. The first is the potency of the drives in the teenage brain, which I think we can can hypothesize certainly in theory might contribute to the rates of paranoid ideas in young people. So I think helping a young person understand their heightened emotion and their heightened brain state is indicated. So normalizing that day to day so that young people understand what's happening to them. And I think the second thing, which is a very obvious one, but it's a really important one, is ask a young person who comes to the clinic or is around your professional space, who has social anxiety and paranoia about their past experiences. Start there. Prof Umar Toseeb: I think for me, it's two parts. The first part is based on something Jess said, which was a young person was experiencing paranoid thoughts or paranoia. There's probably other stuff going on as well. like, you maybe they have depression, anxiety, et cetera, et cetera. So I would imagine that as a researcher, when I'm investigating any other common mental health condition in adolescence, paranoid thoughts might be something that we also measure because these young people who are experiencing these other things might also be experiencing paranoid thoughts and we don't typically look at it as a whole. The second thing is more of a how I'm going to change my practice based on this conversation. I don't usually teach paranoid thoughts, paranoia, even like psychosis, thought disorders, et cetera, as part of my child and adolescent mental health module. And I think I might do it next year because actually it's really interesting. I haven't previously done it because it felt very, this is an adult thing. This isn't a child and adolescent thing, but actually it is a child and adolescent thing. So yeah, I think the students will find it really interesting. Dr. Jane Gilmour: Great, changing the curriculum. Can't get better than that. Producer Matt has reminded me if you set up a free ACAM Learn account at acamlearn.org, you'll get access to these podcasts, of course, and hundreds of hours of evidence based learning from leading academics, researchers and practitioners. And if continuing professional development is important to you, you can test your learning using the associated quizzes, but only if you have an account. Prof Umar Toseeb: Join us again next week when we'll be speaking to Professor Roz Shafran from UCL about youth loneliness and its impacts on mental health.