When they are admitted to psychiatric hospital, opportunities for learning of safety in everyday situations are even more highly restricted. However, many patients with persecutory delusions find it too difficult to enter their feared situations and drop their defences because of the intolerable anxiety generated. This involves re-evaluating the threat beliefs. The target mechanism for successful treatment is for patients to relearn that they are safe (in order to counteract the threat belief). ‘The reason I wasn’t attacked was because I kept away from people’). Patients, for example, often avoid other people, avert their gaze, and remain vigilant, attributing the absence of harm to the use of such actions instead of the inaccuracy of the threat beliefs (e.g. Our cognitive model conceptualises persecutory delusions as unfounded threat beliefs maintained by defence (‘safety-seeking’) behaviours. We take a translational approach, allied to technological advances, for new treatment development for persecutory delusions. Treatment needs to be significantly improved. These are small to moderate effects for a patient group that has severe problems. The median treatment effect size for antipsychotic medications is 0.44, while standard first generation psychological therapy has an effect size of approximately 0.36. However, more than half of patients with psychotic conditions such as schizophrenia do not respond adequately to current treatments. Almost half of individuals with persecutory delusions have levels of psychological well-being in the lowest 2% of the general population. Approximately 70% of patients with schizophrenia have this type of psychotic experience, which typically leads to social withdrawal, suicidal ideation, and hospital admission. ‘People know what I’m thinking and are trying to kill me’). Persecutory delusions are a person’s unfounded beliefs that other people are intending to harm that person (e.g. The treatment is potentially highly scalable for treatment services. The trial will provide the first test of automated cognitive therapy within VR for patients with psychosis. The trial is funded by the Medical Research Council Developmental Pathway Funding Scheme. All main analyses will follow the intention-to-treat principle. ![]() Secondary outcomes include real world distress, activity levels, suicidal ideation, and quality of life. If the interim effect size suggests that the treatment is worth pursuing ( d > 0.1), then the trial will go on to test 90 patients in total. Effect sizes will be re-established by an interim analysis of 30 patients. The primary outcome is degree of conviction in the persecutory delusion (primary endpoint 4 weeks). Assessments will be carried out at 0, 2, 4 (post treatment), 8, 16, and 24 weeks by a researcher blind to treatment allocation. Standard care will remain as usual in both groups. ![]() Each VR treatment will comprise approximately four sessions of 30 min. Patients with persistent persecutory delusions in the context of non-affective psychosis will be randomised (1:1) to the automated VR cognitive treatment or VR mental relaxation (control condition). It will contribute to our wider programme of work developing VR for patients with psychosis. In the THRIVE trial, the automated VR cognitive treatment will be tested against a VR control condition. We have now automated the provision of cognitive therapy within VR using an avatar coach, so that a therapist is not required and the treatment is scalable. A solution is to use virtual reality (VR) social situations, which are graded in difficulty and which patients find much easier to enter. However, this is very difficult for patients due to their severe anxiety. This enables relearning of safety and hence paranoia diminution. The treatment implications are that patients need to (1) go into feared situations and (2) not use defence behaviours. avoidance) that prevent disconfirmatory evidence being processed. Our theoretical model views these delusions as unfounded threat beliefs which persist due to defence behaviours (e.g. Persecutory delusions are a major psychiatric problem and are associated with a wide range of adverse outcomes.
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