Delusions as Embodied Emotions: Rethinking First-Episode Psychosis through Narrative and Phenomenological Inquiry

Beyond the False Belief: The Phenomenological Turn in Psychosis Research

For decades, clinical psychiatry has primarily defined delusions as ‘fixed false beliefs’—cognitive errors or malfunctions in information processing. While this definition serves a diagnostic purpose, it often fails to capture the profound, global transformation of reality experienced by the individual. A recent study published in The Lancet Psychiatry (Ritunnano et al., 2026) challenges this traditional paradigm by presenting delusions not merely as cognitive failures, but as ’embodied emotions.’

This qualitatively driven, multimethod study explores how delusions emerge in first-episode psychosis (FEP) by situating them within the patient’s life narrative and bodily experience. The research suggests that the thematic content of delusions—whether persecutory, grandiose, or religious—is deeply rooted in a person’s history of interpersonal emotions, particularly shame, and a subsequent shift in how they inhabit their own body and the world.

Study Design: A Triangulated Approach to the Mind

To capture the complexity of delusional formation, the researchers employed a novel multi-perspectival design. This approach integrated three distinct analytical standpoints to provide a 360-degree view of the psychotic experience:

1. Standard Clinical Psychopathology (Third-Person)

Using established tools like the Scale for the Assessment of Positive Symptoms (SAPS), the researchers categorized the observable symptoms and delusional themes from a clinical distance.

2. Phenomenological Psychopathology (Top-Down First-Person)

Utilizing the Examination of Anomalous World Experience (EAWE) interview, the study explored the structure of the patient’s subjective experience, focusing on alterations in selfhood, spatiality, and reality-feeling.

3. Narrative Inquiry (Bottom-Up First-Person)

Through the ad-hoc Life Story Interview, the researchers mapped the participant’s life history, identifying the emotional and contextual precursors that preceded the onset of psychosis.

Between January and June 2023, the study recruited 10 adults with first-episode psychosis from Early Intervention in Psychosis (EIP) teams in the UK. The cohort was diverse in gender (three men, six women, one non-binary) with a median age of 24.5 years. Despite the small sample size, the depth of the 33 interview sessions provided a rich data set for meta-inference.

Key Findings: The Emotional Architecture of Delusion

The findings revealed that delusions do not occur in isolation. All ten participants reported persecutory themes, while 90% experienced delusions of reference and 90% reported grandiose or religious themes. The phenomenological analysis (EAWE) showed a significant global shift in subjective experience, with mean scores of 26.5, indicating profound disturbances in how reality is perceived.

Theme 1: The Pre-Psychotic Emotional Landscape

The narrative inquiry revealed that the ‘soil’ from which delusions grew was often tilled by early and repeated negative interpersonal emotions. Recurrent shame, anger, and fear were central. Many participants described a history of feeling controlled by others or the environment. Before the onset of clinical delusions, these individuals often employed ‘experiential avoidance’—withdrawing from a painful reality—or became ‘absorbed’ in intense internal states as a way to cope with emotional upheaval.

Theme 2: The Transformation of Self and World

The study identified three main patterns of how these emotions transformed into a delusional reality:

• From Shame to Invincibility: Participants who felt ‘under the spotlight’ of social shame often experienced a flip into grandiose delusions. Embodied shame transformed into ‘almighty invincibility,’ a way for the self to survive an unbearable social environment.
• From Absence to Embodied Love: For those experiencing meaninglessness or emotional absence, delusions of a religious or cosmic nature provided a sense of being ‘part of something bigger,’ shifting the experience from void to a state of embodied awe and hope.
• The Simulation: Some experienced a total detachment, feeling as though they were living in a simulation without a body, completely cut off from the human world.

Interpretation: Delusion as a Unified Conscious Experience

The researchers argue that the emergence of a delusion is a temporally extended, embodied process. It is not just a thought; it is a way of being. A critical mechanism identified is ‘metonymic thinking.’ This is where contiguous bodily experiences become the basis for extreme appraisals. For example, a physical sensation of tension or ‘wrongness’ in the body might be linguistically and cognitively interpreted as ‘being a bad person’ or ‘being under surveillance.’

This suggests that the ‘incomprehensible’ nature of delusions becomes more understandable when viewed through the lens of the person’s history. The delusion is an attempt to make sense of a body and a world that have undergone a radical emotional transformation.

Expert Commentary and Clinical Implications

This study has significant implications for how we treat first-episode psychosis. If delusions are indeed ’embodied emotions,’ then purely cognitive interventions (like challenging the logic of the belief) may be insufficient because they do not address the underlying affective and bodily shift.

Targeting the Lived Body

Therapeutic models should consider the role of the ‘lived body’ in emotion regulation. Interventions that focus on grounding, sensory integration, and bodily awareness may help stabilize the ‘global shift’ in experience that precedes the crystallization of a delusion.

Contextual and Social Regulation

The study highlights that the surrounding material and social environments act as central affective-regulatory mechanisms. If an environment is characterized by shame and threat, the individual’s embodied state will reflect that. Clinical support must therefore move beyond the individual to address the social ‘affordances’—the opportunities for safe interaction and belonging—available to the patient.

Conclusion

Ritunnano and colleagues provide a compelling argument for a more holistic, phenomenological approach to psychosis. By viewing delusions as a unified conscious experience involving emotion, body, and narrative, clinicians can move toward a more empathetic and effective form of care. This research underscores that even the most ‘extreme’ delusional appraisals are often rooted in the universal human need to navigate shame, find meaning, and survive emotional upheaval.

Funding and Acknowledgments

This study was funded by the Priestley Scholarship and the Wellcome Trust. The authors express gratitude to the individuals with lived experience who contributed to the study design and protocol.

References

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. Lancet Psychiatry. 2026 Feb;13(2):125-139. doi: 10.1016/S2215-0366(25)00341-4. Epub 2026 Jan 12. PMID: 41539315.