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Reducing worry with CBT improves persecutory delusions

Cognitive behavioral therapy may reduce a thinking style of worry – a contributory cause of paranoia, according to Daniel Freeman, PhD.

“We have now shown in a rigorous clinical trial – the first large-scale study focused on severe paranoia – that just six sessions of a focused form of cognitive therapy can reduce worry and, consequently, the paranoia. These benefits were maintained over at least six months. Patients also reported being happier and having fewer psychiatric symptoms overall,” Freeman, an MRC senior clinical fellow and consultant clinical psychologist in the department of psychiatry at the University of Oxford, told Healio.com/Psychiatry.

Daniel Freeman

The Worry Intervention Trial (WIT) included patients aged 18 to 65 years with persistent persecutory delusions, but non-affective psychosis from the Oxford Health National Health Service Foundation Trust in Oxford, and the Southern Health NHS Foundation Trust in Southampton, United Kingdom.

Patients were randomly assigned to either six sessions of worry-reduction cognitive behavioral therapy (CBT) over an 8-week period in addition to usual care (n = 73), or to usual care alone (n = 77). The researchers assessed outcomes at baseline, 8 and 24 weeks.

Eight-week data indicate the intervention significantly reduced worry (P < .001) and persecutory delusions (P = .005), which were consistent through 24 weeks of follow-up.

Improvements to worry were attributed to 66% of changes to delusions, according to data.

“The psychological intervention undoubtedly has benefits for patients with diagnoses such as schizophrenia. However, there are many contributory causes of paranoia,” Freeman told Healio.com/Psychiatry.

Adverse events included six suicide attempts among two patients in the intervention group and four in the control group, the researchers wrote. One patient from each group was involved in serious violent incidents, they added.

“Our aim is to develop interventions focused upon each cause, show that they work, and then combine in a much more efficacious treatment. We want an intervention that will lead to recovery in persistent paranoia for many people,” Freeman said.

The pilot study examining such a combined intervention is underway in Oxford, he said. – by Samantha Costa

Disclosure: Freeman reports no relevant financial disclosures. Funding for this study was provided by the UK Medical Research Council and National Institute of Health Research partnership: Efficacy and Mechanism Evaluation program. Please see the full study for a list of all other authors’ relevant financial disclosures.