Almudena Trucharte ^1,2,3 Valiente Carmen ³ Javier Pacios ^4,5 Ricardo Bruña ^4,6,7 Regina Espinosa Lopez ^1,2 Vanesa Peinado ³ Teodoro Pascual ⁸ Dr Anton P. Martinez ⁹ Fernando Maestu ^4,5,6 Richard Bentall ^9*

• ¹ Facultad HM Hospitales de Ciencias de la Salud Universidad Camilo José Cela, Madrid, Asturias, Spain
• ² Instituto de investigación Sanitaria HM Hospitales, Madrid, Spain, Madrid, Spain
• ³ Departamento de Personalidad, Evaluación y Psicología Clínica, Facultad de Psicología, Universidad Complutense de Madrid, Madrid, Madrid, Spain
• ⁴ Center for Cognitive and Computational Neuroscience, Complutense University of Madrid, Madrid, Madrid, Spain
• ⁵ Department of Experimenal Psychology, School of Physchology, Universidad Compluense de Madrid, 28231, Spain, Madrid, Spain
• ⁶ Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Madrid, Spain
• ⁷ Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Medicine, Complutense University of Madrid, Madrid, Madrid, Spain
• ⁸ Faculty of Health and Education, Camilo José Cela University, Madrid, Catalonia, Spain
• ⁹ Department of Psychology, Faculty of Science, The University of Sheffield, Sheffield, England, United Kingdom

Introduction: Much research on the treatment of paranoia has involved cognitivebehavioural interventions that address explicit social cognition processes. However, much of human cognition is preverbal or implicit, raising the possibility that such social judgements are implicated in paranoia. One type of implicit social cognition that has been investigated concerning paranoia is implicit self-esteem with some evidence that it may be possible to change implicit self-esteem using techniques based on conditioning theory. Therefore, the primary purpose of this research is to further evaluate the potential of this approach. At the same time, as a secondary purpose, we introduce a novel way of measuring social cognition that, we argue, has utility for investigating the psychological processes involved in paranoia.We conducted two proof-of-concept studies of a novel brief intervention based on evaluative conditioning, targeting implicit cognition. The first study was conducted with a large non-clinical sample, while the second study included a small series of psychotic patients. As part of our proof-of-concept evaluation of the potential of evaluative conditioning, we attempted to probe for neurophysiological changes following the intervention using magnetoencephalography in an exploratory way in the clinical sample. Results: Our results revealed that both non-clinical and clinical participants in the experimental group showed a significant change in how they evaluated themselves in the social cognition task, which could be related to the perception of social information in a less threatening way. In addition, clinical participants in the experimental group showed changes in brain activity during the social cognition task, particularly in regions involved in emotional reactivity and mentalisation processes. Discussion: Our results are encouraging, suggesting that implicit cognition is manipulable, that such manipulation affects underlying neurophysiological mechanisms, and that there may be an impact on paranoid symptoms. However, much more work is required to determine whether this approach can produce meaningful clinical change and be delivered in routine clinical settings. Finally, it is important to note that we are not claiming the clinical effectiveness of our intervention, which is in a very early stage of development. Our goal here is to demonstrate clinical possibilities that warrant further investigation