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Feeling Safe therapy offers new hope for patients with psychosis

A clinical trial funded by the National Institute for Health Research (NIHR) demonstrates the life-changing potential of a therapy for patients with psychosis, by supporting their return to everyday activities.

The trial results, published today in the Lancet Psychiatry, show that the new Feeling Safe programme is the most effective psychological treatment for persecutory delusions (unfounded, strong beliefs that other people intend to harm you).

In the study, 50% of patients achieved significant benefits from the Feeling Safe programme, and a further 25% made moderate gains. This new therapy has potential to transform quality of life, given the deep impact of persecutory delusions on health and wellbeing. Four out of five people affected are unemployed and withdrawn from social and leisure activities, and life expectancy is on average 14.5 years shorter, due to largely preventable health conditions exacerbated by inactivity. 

NIHR Research Professor Daniel Freeman, Department of Psychiatry, University of Oxford, was the lead investigator for the Feeling Safe trial. His research team, supported by the NIHR Oxford Health Biomedical Research Centre, conducted a randomised controlled trial with 130 patients for whom delusions persisted despite standard treatments. 

Professor Freeman said: “Feeling Safe is the result of more than ten years of research and clinical practice, built on listening carefully to patients to really understand the causes of the problems they face. The trial results give us great cause for optimism in the treatment of a problem that is very common in people with psychosis, immensely distressing for patients and families, and yet often does not improve sufficiently with current treatments.”

Delivered in 20 sessions, the Feeling Safe programme involves patients fully in decisions about their treatment. Based on the belief that people make gains by trying out everyday things, the therapy helps patients develop new memories of safety and addresses factors that often maintain persecutory thoughts, such as worry, poor sleep, and low self-confidence.

Dr Felicity Waite, clinical psychologist in the Department of Psychiatry, University of Oxford, said: “So many of the patients we visited were spending virtually all their time at home. Our aim was to bring them back into everyday life, to help them get back to the things they like doing. The positive change Feeling Safe brought about is wonderful to see.”

A Feeling Safe participant said: “I missed out on so many things in life, meeting my friends, family events, meals, training, sports, I was just in a very paranoid state. After a life-changing study – for me – I feel very, very safe. It worked. It really did. You get better sleep, feel more confident, active in the day. It’s profoundly changed my life. I don’t have to worry any more about people potentially attacking me. That’s all floated away.”

The study, Comparison of a theoretically driven cognitive therapy (the Feeling Safe Programme) with befriending for the treatment of persistent persecutory delusions: a parallel, single-blind, randomised controlled trial’ is published in the Lancet Psychiatry. 

Watch this short video for an explanation of the Feeling Safe programme.

Professor Daniel Freeman is a NIHR Research Professor. This five-year award funds outstanding academics to work at professorial level. Find out more about NIHR Research Professorships.