Attentional bias in paranoia: systematic review and meta-analysis

Laura Eid; Chloe Hampshire; George Vamvakas; Pamela Jacobsen; Daniel Stahl; Jenny Yiend

doi:10.1192/bjo.2026.10993

Attentional bias in paranoia: systematic review and meta-analysis

Laura Eid, Chloe Hampshire, George Vamvakas, Pamela Jacobsen, Daniel Stahl, Jenny Yiend

King's College London

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Paranoia is a transdiagnostic symptom and is associated with cognitive and social impairments. Attentional bias toward threat is thought to maintain paranoia.

Aims: Despite many studies, attentional biases in paranoia have not been systematically summarised, which was the aim of the current work.

Method: We conducted a systematic review and meta-analysis, identifying 10 964 studies, of which 35 met inclusion criteria for review and 15 for meta-analysis.

Results: Findings showed a significant negative attentional bias (average standardised effect size 0.26; 95% CI 0.01–0.52; p = 0.046). Preliminary indications suggested bias was strongest for paranoia-related stimuli (average effect size 0.30; 95% CI 0.03–0.57; p = 0.027) and stronger for words than faces (average effect size 0.41; 95% CI 0.05–0.77; p = 0.027), but more data is needed to confirm these effects. Limitations were primarily statistical and included likely underestimation of the overall effect size of the association between negative attentional bias and paranoia and a lack of sufficient studies to robustly examine moderators.

Conclusions: Summarising this literature provides a rationale for existing and new interventions for paranoia that target biased attentional mechanisms.

Original language	English
Article number	e100
Journal	BJPsych Open
Volume	12
Issue number	3
Early online date	6 Apr 2026
DOIs	https://doi.org/10.1192/bjo.2026.10993
Publication status	Published - 31 May 2026

Acknowledgements

For the purposes of open-access, the author has applied a Creative Commons Attribution (CC BY) licence to any Accepted Author Manuscript version arising from this submission. We would like to express our gratitude to the National Institute for Health and Care Research (NIHR) Biomedical Research Centre hosted at South London and Maudsley NHS Foundation Trust in partnership with King’s College London. The views expressed are those of the author(s) and not necessarily those of the National Health Service, the NIHR, Department of Health and Social Care, the Economic and Social Research Council or King’s College London.

Funding

At the time of this work, J.Y. was part-funded by the NIHR Biomedical Research Centre hosted at South London and Maudsley NHS Foundation Trust in partnership with King’s College London and the Medical Research Council Biomedical Catalyst: Developmental Pathway Funding Scheme (reference: MR/V027484/1). For the purposes of open-access, the author has applied a Creative Commons Attribution(CC BY) licence to any Accepted Author Manuscript version arising from this submission.We would like to express our gratitude to the National Institute for Health and CareResearch (NIHR) Biomedical Research Centre hosted at South London and Maudsley NHSFoundation Trust in partnership with King’s College London. The views expressed are thoseof the author(s) and not necessarily those of the National Health Service, the NIHR,Department of Health and Social Care, the Economic and Social Research Council or King’sCollege London.

Funders	Funder number
Department of Health and Social Care
Economic and Social Research Council
National Institute for Health and Care Research
South London and Maudsley NHS Foundation Trust
NIHR Biomedical Research Centre
Medical Research Council	MR/V027484/1

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

attention bias
cognition
meta-analysis
paranoia
Psychosis
systematic review
threat

ASJC Scopus subject areas

Psychiatry and Mental health

Access to Document

10.1192/bjo.2026.10993Licence: CC BY

Cite this

@article{be819ff3832242d9ab333f3b84bfb67b,

title = "Attentional bias in paranoia: systematic review and meta-analysis",

abstract = "Background: Paranoia is a transdiagnostic symptom and is associated with cognitive and social impairments. Attentional bias toward threat is thought to maintain paranoia. Aims: Despite many studies, attentional biases in paranoia have not been systematically summarised, which was the aim of the current work. Method: We conducted a systematic review and meta-analysis, identifying 10 964 studies, of which 35 met inclusion criteria for review and 15 for meta-analysis. Results: Findings showed a significant negative attentional bias (average standardised effect size 0.26; 95\% CI 0.01–0.52; p = 0.046). Preliminary indications suggested bias was strongest for paranoia-related stimuli (average effect size 0.30; 95\% CI 0.03–0.57; p = 0.027) and stronger for words than faces (average effect size 0.41; 95\% CI 0.05–0.77; p = 0.027), but more data is needed to confirm these effects. Limitations were primarily statistical and included likely underestimation of the overall effect size of the association between negative attentional bias and paranoia and a lack of sufficient studies to robustly examine moderators. Conclusions: Summarising this literature provides a rationale for existing and new interventions for paranoia that target biased attentional mechanisms.",

keywords = "attention bias, cognition, meta-analysis, paranoia, Psychosis, systematic review, threat",

author = "Laura Eid and Chloe Hampshire and George Vamvakas and Pamela Jacobsen and Daniel Stahl and Jenny Yiend",

year = "2026",

month = may,

day = "31",

doi = "10.1192/bjo.2026.10993",

language = "English",

volume = "12",

journal = "BJPsych Open",

issn = "2056-4724",

publisher = "Cambridge University Press",

number = "3",

}

TY - JOUR

T1 - Attentional bias in paranoia

T2 - systematic review and meta-analysis

AU - Eid, Laura

AU - Hampshire, Chloe

AU - Vamvakas, George

AU - Jacobsen, Pamela

AU - Stahl, Daniel

AU - Yiend, Jenny

PY - 2026/5/31

Y1 - 2026/5/31

N2 - Background: Paranoia is a transdiagnostic symptom and is associated with cognitive and social impairments. Attentional bias toward threat is thought to maintain paranoia. Aims: Despite many studies, attentional biases in paranoia have not been systematically summarised, which was the aim of the current work. Method: We conducted a systematic review and meta-analysis, identifying 10 964 studies, of which 35 met inclusion criteria for review and 15 for meta-analysis. Results: Findings showed a significant negative attentional bias (average standardised effect size 0.26; 95% CI 0.01–0.52; p = 0.046). Preliminary indications suggested bias was strongest for paranoia-related stimuli (average effect size 0.30; 95% CI 0.03–0.57; p = 0.027) and stronger for words than faces (average effect size 0.41; 95% CI 0.05–0.77; p = 0.027), but more data is needed to confirm these effects. Limitations were primarily statistical and included likely underestimation of the overall effect size of the association between negative attentional bias and paranoia and a lack of sufficient studies to robustly examine moderators. Conclusions: Summarising this literature provides a rationale for existing and new interventions for paranoia that target biased attentional mechanisms.

AB - Background: Paranoia is a transdiagnostic symptom and is associated with cognitive and social impairments. Attentional bias toward threat is thought to maintain paranoia. Aims: Despite many studies, attentional biases in paranoia have not been systematically summarised, which was the aim of the current work. Method: We conducted a systematic review and meta-analysis, identifying 10 964 studies, of which 35 met inclusion criteria for review and 15 for meta-analysis. Results: Findings showed a significant negative attentional bias (average standardised effect size 0.26; 95% CI 0.01–0.52; p = 0.046). Preliminary indications suggested bias was strongest for paranoia-related stimuli (average effect size 0.30; 95% CI 0.03–0.57; p = 0.027) and stronger for words than faces (average effect size 0.41; 95% CI 0.05–0.77; p = 0.027), but more data is needed to confirm these effects. Limitations were primarily statistical and included likely underestimation of the overall effect size of the association between negative attentional bias and paranoia and a lack of sufficient studies to robustly examine moderators. Conclusions: Summarising this literature provides a rationale for existing and new interventions for paranoia that target biased attentional mechanisms.

KW - attention bias

KW - cognition

KW - meta-analysis

KW - paranoia

KW - Psychosis

KW - systematic review

KW - threat

UR - https://www.scopus.com/pages/publications/105035170976

U2 - 10.1192/bjo.2026.10993

DO - 10.1192/bjo.2026.10993

M3 - Article

SN - 2056-4724

VL - 12

JO - BJPsych Open

JF - BJPsych Open

IS - 3

M1 - e100

ER -

Attentional bias in paranoia: systematic review and meta-analysis

Abstract

Acknowledgements

Funding

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Modifying cognitive biases in psychosis

Cite this

Attentional bias in paranoia: systematic review and meta-analysis

Abstract

Acknowledgements

Funding

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Projects

Modifying cognitive biases in psychosis

Cite this