Theory driven psychological therapy for persecutory delusions: trajectories of patient outcomes

Lucy Jenner; Mollie Payne; Felicity Waite; Helen Beckwith; Rowan Diamond; Louise Isham; Nicola Collett; Richard Emsley; Daniel Freeman

doi:10.1017/S0033291724002113

Theory driven psychological therapy for persecutory delusions: trajectories of patient outcomes

Lucy Jenner^*, Mollie Payne, Felicity Waite, Helen Beckwith, Rowan Diamond, Louise Isham, Nicola Collett, Richard Emsley, Daniel Freeman

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

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.

Original language	English
Journal	Psychological Medicine
DOIs	https://doi.org/10.1017/S0033291724002113
Publication status	Accepted/In press - 2024

Keywords

cognitive therapy
delusions
outcome trajectories
persecutory
psychosis

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10.1017/S0033291724002113

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@article{7a454dabf2f04855bf6e166c8d833a03,

title = "Theory driven psychological therapy for persecutory delusions: trajectories of patient outcomes",

abstract = "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.",

keywords = "cognitive therapy, delusions, outcome trajectories, persecutory, psychosis",

author = "Lucy Jenner and Mollie Payne and Felicity Waite and Helen Beckwith and Rowan Diamond and Louise Isham and Nicola Collett and Richard Emsley and Daniel Freeman",

note = "Publisher Copyright: {\textcopyright} The Author(s), 2024.",

year = "2024",

doi = "10.1017/S0033291724002113",

language = "English",

journal = "Psychological Medicine",

issn = "0033-2917",

publisher = "Cambridge University Press",

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TY - JOUR

T1 - Theory driven psychological therapy for persecutory delusions

T2 - trajectories of patient outcomes

AU - Jenner, Lucy

AU - Payne, Mollie

AU - Waite, Felicity

AU - Beckwith, Helen

AU - Diamond, Rowan

AU - Isham, Louise

AU - Collett, Nicola

AU - Emsley, Richard

AU - Freeman, Daniel

PY - 2024

Y1 - 2024

N2 - 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.

AB - 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.

KW - cognitive therapy

KW - delusions

KW - outcome trajectories

KW - persecutory

KW - psychosis

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U2 - 10.1017/S0033291724002113

DO - 10.1017/S0033291724002113

M3 - Article

AN - SCOPUS:85209646921

SN - 0033-2917

JO - Psychological Medicine

JF - Psychological Medicine

ER -

Theory driven psychological therapy for persecutory delusions: trajectories of patient outcomes

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