Journal article
A six-month supported online programme for the treatment of persecutory delusions: Feeling Safer
- Abstract:
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Background: Based on an efficacious face-to-face theory-driven psychological therapy for persecutory delusions in the context of psychosis, we set out to develop a scalable guided six-month online programme. The aim was an intervention that patients can easily access and use, produces large clinical effects, and can be supported by a range of mental health professionals in less contact time than faceto-face therapy. We report here the proof-of-concept clinical testing. At least moderate-sized clinical effects were required to progress to a randomised controlled trial.
Methods: In the six-month Feeling Safer online programme, a certified medical device, patients complete a brief assessment and then are provided with up to ten modules that match their difficulties. As the patient progresses through the programme, regular remote meetings with a mental health professional take place. These may be supplemented by in-person visits. A pre- to post-treatment cohort trial was conducted with fourteen patients with persistent persecutory delusions. The primary outcome was the Psychotic Symptoms Rating Scale (PSYRATS)-Delusions.
Results: Satisfaction and usability ratings of the programme were high. Very large reductions in persecutory delusions were observed (PSYRATS mean reduction=7.1, 95% C.I.=3.4, 10.8, n=13, Cohen’s d=3.0). There were large improvements in paranoia, anxiety, depression, agoraphobic distress, psychological wellbeing, meaningful activity, personal recovery, recovering quality of life, and moderate improvements in insomnia, agoraphobic avoidance, and quality of life.
Conclusions: The clinical effects associated with Feeling Safer were very high, comparable to those seen in the evaluations of the face-to-face therapy, and enable progression to a randomised controlled trial.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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- Files:
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(Preview, Version of record, pdf, 279.0KB, Terms of use)
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- Publisher copy:
- 10.1017/s0033291725100676
Authors
- Funder identifier:
- https://ror.org/0187kwz08
- Grant:
- NIHR204013
- Publisher:
- Cambridge University Press
- Journal:
- Psychological Medicine More from this journal
- Volume:
- 55
- Article number:
- e179
- Publication date:
- 2025-06-30
- Acceptance date:
- 2025-05-13
- DOI:
- EISSN:
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1469-8978
- ISSN:
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0033-2917
- Language:
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English
- Pubs id:
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2123696
- Local pid:
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pubs:2123696
- Deposit date:
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2025-05-14
Terms of use
- Copyright holder:
- Freeman et al
- Copyright date:
- 2025
- Rights statement:
- © The Author(s), 2025. Published by Cambridge University Press. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
- Notes:
- This article has been accepted for publication in Psychological Medicine.
- Licence:
- CC Attribution (CC BY)
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