Revised Green et al. Paranoid Thoughts Scale

The Revised Green et al.

Questions: 18
Duration: 5 min
Original title: R-GPTS — Revised Green et al. Paranoid Thoughts Scale
Adaptation: Revised Green et al. Paranoid Thoughts Scale
Authors: Freeman, Loe, Kingdon, Startup, Molodynski, Rosebrock, Brown, Sheaves, Waite & Bird
Created: 2021

The Revised Green et al. Paranoid Thoughts Scale (R-GPTS) is an essential, widely validated measure for evaluating paranoid ideation across both clinical and non-clinical populations. Derived from the original 32-item scale, this 18-item revision removes problematic items to offer a highly reliable, precise assessment of paranoia. It distinguishes between milder social-evaluative concerns, such as ideas of reference, and more severe persecutory thoughts, reflecting the established continuum model of psychosis.

For mental health professionals, the R-GPTS provides a structured way to gauge the intensity and frequency of paranoid thoughts over the past month. Using this tool in session helps anchor discussions around psychotic-spectrum experiences and related cognitive processes without relying solely on clinical impression. It also facilitates the exploration of cognitive biases such as jumping to conclusions that often fuel persecutory beliefs.

Because the R-GPTS is sensitive to shifts in paranoia severity, it is particularly valuable for establishing a baseline during intake and monitoring therapeutic progress. Its validated clinical cut-offs also aid in identifying individuals who may be experiencing likely persecutory delusions, informing the overall case formulation and guiding specialized interventions.

Example result

Fictitious result, computed from a sample set of answers.

Revised version (2021) of the Green et al. Paranoid Thoughts Scale: 18 items scored from 0 to 4 over the past month, across two independent scales — ideas of reference (8 items, 0–32) and persecutory ideas (10 items, 0–40). Derived through IRT analysis from over 10,000 participants, it provides validated severity grades and clinical cutoffs (11: clinical level of paranoia; 18: probable persecutory delusion). French translation: shared items retain the wording of the validated French GPTS; items specific to the revised version are translated from the source article (non-validated translation).

Ideas of reference (Part A)

13/ 32

Ideas of reference: impression that others are talking about oneself, making references to oneself, or mocking oneself.

items 1, 2, 3, 4, 5, 6, 7, 8

0–9

Average

10–15

Elevated

16–20

Moderately severe

21–24

Severe

25–32

Very severe

généralemixed · general population · general population · United Kingdom · n = 774 · 2021 · Freeman et al. (2021)

032

M = 6.77 ± 5.54

cliniquemixed · pathology: mental health disorders · United Kingdom · n = 32 · 2021 · Freeman et al. (2021)

032

M = 9.43 ± 8.06

cliniquemixed · pathology: psychosis · United Kingdom · n = 62 · 2021 · Freeman et al. (2021)

032

M = 15.8 ± 7.42

cliniquemixed · pathology: persecutory delusions · United Kingdom · n = 360 · 2021 · Freeman et al. (2021)

032

M = 19.9 ± 7.8

Persecutory ideas (Part B)

20/ 40

Persecutory ideas: conviction that others are deliberately seeking to cause harm.

items 9, 10, 11, 12, 13, 14, 15, 16, 17, 18

0–5

Average

6–10

Elevated

11–17

Moderately severe

18–27

Severe

28–40

Very severe

généralemixed · general population · general population · United Kingdom · n = 7297 · 2021 · Freeman et al. (2021)

040

M = 4.52 ± 6.74

cliniquemixed · pathology: mental health disorders · United Kingdom · n = 982 · 2021 · Freeman et al. (2021)

040

M = 8.21 ± 9.35

cliniquemixed · pathology: psychosis · United Kingdom · n = 1804 · 2021 · Freeman et al. (2021)

040

M = 13.7 ± 13

cliniquemixed · pathology: persecutory delusions · United Kingdom · n = 360 · 2021 · Freeman et al. (2021)

040

M = 26.1 ± 9.46

For information

Cut-off≥ 11Clinical level of paranoia

Recommended cutoff to discriminate a clinical level of paranoid ideation.

Freeman et al. (2021)View the study ↗

Cut-off≥ 18Probable presence of a persecutory delusion

Recommended cutoff for probable persecutory delusion: 81 % of patients with confirmed delusion exceed it, compared to 7 % of the non-clinical population.

Freeman et al. (2021)View the study ↗

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What the test measures

The R-GPTS assesses the frequency and severity of paranoid beliefs over the preceding month, capturing a spectrum that ranges from mild interpersonal hypersensitivity to overt persecutory ideation. The 18 items are divided into two clinical facets:

Ideas of Reference: Captures social-evaluative concerns, such as the feeling of being talked about, judged critically, or targeted by subtle hints, which often represent the foundational levels of the paranoia hierarchy.
Persecutory Ideation: Evaluates the belief that others are deliberately intending to cause harm, confuse, or threaten the individual, reflecting more severe, distress-inducing paranoia that can trigger rigid maintenance cycles.

This instrument is intended for adults in both clinical settings (such as those diagnosed with schizophrenia-spectrum disorders) and general population samples experiencing distress.

When and why to use it

Clinicians typically administer the R-GPTS when a patient presents with high interpersonal mistrust, social withdrawal, or suspected psychosis. It provides a standardized framework to discuss sensitive beliefs and orient the clinical focus.

Intake baseline: To map the patient's initial severity of paranoia and distinguish between generalized anxiety and true persecutory ideation.
Screening and thresholds: To identify severe clinical levels of persecution that strongly suggest the presence of a persecutory delusion, warranting specialized care.
Monitoring change: To evaluate the effectiveness of interventions over time, as the scale is highly sensitive to fluctuations in paranoid thoughts.
Differential support: To clarify the clinical picture when symptoms overlap with severe social anxiety or trauma, ensuring the treatment plan targets the core mechanisms rather than superficial behaviors.

Integrating a validated score offers a clear, objective metric of paranoia severity that complements clinical judgment, allowing for calibrated decision-making and reliable progress tracking.

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The questions

Please read each of the statements carefully. They refer to thoughts and feelings you may have had about others over the last month. Think about the last month and indicate the extent of these feelings from 0 (Not at all) to 4 (Totally). (Please do not rate items according to any experiences you may have had under the influence of drugs.)
1. I have spent time thinking that friends are gossiping about me.
Probes the frequency of rumination regarding suspected negative conversations within the patient's social circle.
- Not at all
- A little
- Moderately
- A lot
- Totally
2. I have often heard people talking about me.
Assesses the presence of self-referential beliefs and the feeling of being talked about in daily environments.
- Not at all
- A little
- Moderately
- A lot
- Totally
3. I have been upset by friends and colleagues judging me critically.
Evaluates the emotional impact of perceived critical evaluation by familiar others.
- Not at all
- A little
- Moderately
- A lot
- Totally
4. People have clearly laughed at me behind my back.
Captures the conviction that the patient is the target of covert mockery.
- Not at all
- A little
- Moderately
- A lot
- Totally
5. I have thought a lot about people avoiding me.
Measures the degree of preoccupation with perceived social ostracism or deliberate exclusion.
- Not at all
- A little
- Moderately
- A lot
- Totally
6. People have dropped hints about me.
Investigates the tendency to interpret innocuous communications or events as carrying hidden, self-directed messages.
- Not at all
- A little
- Moderately
- A lot
- Totally
7. I have believed that certain people were not what they seemed.
Probes generalized interpersonal suspicion and the attribution of deceptive motives to others.
- Not at all
- A little
- Moderately
- A lot
- Totally
8. I have felt upset by people talking about me behind my back.
Assesses the level of distress caused by the belief that one is the subject of hidden discussions.
- Not at all
- A little
- Moderately
- A lot
- Totally
9. Certain people have it in for me.
Evaluates the conviction that specific people hold malicious intent toward the patient.
- Not at all
- A little
- Moderately
- A lot
- Totally
10. People have stared at me to make me feel threatened.
Captures the interpretation of neutral visual attention as a deliberate act of intimidation.
- Not at all
- A little
- Moderately
- A lot
- Totally
11. I have been certain that people have done things deliberately to annoy me.
Measures the tendency to attribute frustrating everyday occurrences to the intentional malice of others.
- Not at all
- A little
- Moderately
- A lot
- Totally
12. I have been convinced that there was a conspiracy against me.
Probes for organized, systematized beliefs of a coordinated plot targeting the individual.
- Not at all
- A little
- Moderately
- A lot
- Totally
13. I have been sure that someone wanted to harm me.
Assesses the direct fear of impending, intentional harm from another person.
- Not at all
- A little
- Moderately
- A lot
- Totally
14. I couldn't stop thinking that people wanted to confuse me.
Evaluates the patient's rumination over the belief that others are actively trying to manipulate or disorient them.
- Not at all
- A little
- Moderately
- A lot
- Totally
15. I have been distressed by being persecuted.
Captures the subjective emotional burden and suffering associated with feeling actively persecuted.
- Not at all
- A little
- Moderately
- A lot
- Totally
16. I couldn't stop thinking about people who wanted to make me feel bad.
Measures the degree of cognitive fusion and difficulty disengaging from thoughts of intentional emotional harm.
- Not at all
- A little
- Moderately
- A lot
- Totally
17. People have deliberately been hostile towards me.
Probes the perception of overt, intentional hostility directed at the patient in social interactions.
- Not at all
- A little
- Moderately
- A lot
- Totally
18. I have been angry because someone wanted to harm me.
Assesses the affective response of anger in reaction to perceived malicious intent.
- Not at all
- A little
- Moderately
- A lot
- Totally