Theory driven psychological therapy for persecutory delusions: trajectories of patient outcomes
Open accessAbstract
Background: We aimed to identify the common types of outcome trajectories for patients with psychosis who take up specialist psychological therapy for persecutory delusions. Knowing the different potential responses to therapy can inform expectations. Further, determining predictors of different outcomes may help in understanding who may benefit. Methods: We analyzed delusion conviction data from 767 therapy sessions with 64 patients with persistent persecutory delusions (held with at least 60% conviction) who received a six-month psychological intervention (Feeling Safe) during a clinical trial. Latent class trajectory analysis was conducted to identify groups with distinct outcome profiles. The trajectories were validated against independent assessments, including a longer-term follow-up six months after the end of therapy. We also tested potential predictors of the trajectories. Results: There were four outcome trajectories: (1) Very high delusion conviction/Little improvement (n = 14, 25%), (2) Very high delusion conviction/Large improvement (n = 9, 16%), (3) High delusion conviction/Moderate improvement (n = 17, 31%) and (4) High delusion conviction/Large improvement (n = 15, 27%). The groups did not differ in initial overall delusion severity. The trajectories were consistent with the independent assessments and sustained over time. Three factors predicted trajectories: persecutory delusion conviction, therapy expectations, and positive beliefs about other people. Conclusions: There are variable responses to psychological therapy for persecutory delusions. Patients with very high delusion conviction can have excellent responses to therapy, though this may take a little longer to observe and such high conviction reduces the likelihood of positive responses. A trajectory approach requires testing in larger datasets but may prove highly informative.
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This approach generally produces a range of positive outcomes.
“This approach generally produces a range of positive outcomes (Freeman et al., 2021; Jenner et al., 2024).”
From A counterweight model for understanding and treating persecutory delusions. (2025) · cites this paper as Jenner et al., 2024
The Results (page not available in our copy) report moderate or large improvement in delusion conviction for most patients receiving Feeling Safe therapy, but little improvement for 25%. The paper supports a generally positive response in this trial, while its trajectory analysis does not establish a range of distinct positive outcomes or that the approach generally produces them beyond this setting. (LLM, conf=0.84)
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A counterweight model for understanding and treating persecutory delusions.
Freeman, D., Isham, L., & Waite, F. (2025) · Psychological Medicine · doi:10.1017/s0033291725001242 · Cited by 15 · see citing works
“This approach generally produces a range of positive outcomes (Freeman et al., 2021; Jenner et al., 2024).”
Self-citation
- Authors
- Jenner, L., Payne, M., Waite, F., Beckwith, H., Diamond, R., Isham, L., Collett, N., Emsley, R., & Freeman, D.
- Affiliations
- King's College London (GB)
- Oxford Health NHS Foundation Trust (GB)
- University of Oxford (GB)
- Aneurin Bevan University Health Board (GB)
- Corresponding author
- Jenner, Lucy
- ORCID
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2024-11
- Volume
- 54
- Issue
- 15
- Pages
- 4173-4181
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- PMC
- PMC11650162
- OpenAlex
- W4404474357
- Cited by
- 10
- References
- 7
- Citations by year
- 2026: 6 · 2025: 4
- FWCI
- 2.94
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Psychological Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by)
- Funders
- National Institute for Health and Care Research (NIHR302628)
- Wellcome Trust (102176/B/13/Z)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- persecutory delusions, psychosis, psychotherapy, feeling safe, outcome trajectories, latent class analysis, predictors of treatment response
- MeSH terms
- Adult, Delusions, Female, Humans, Male, Middle Aged, Psychotherapy, Psychotic Disorders, Cognitive Behavioral Therapy, Treatment Outcome, Outcome Assessment, Health Care, Young Adult
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