title: An early Phase II randomised controlled trial testing the effect on persecutory delusions of using CBT to reduce negative cognitions about the self: the potential benefits of enhancing self confidence.
abstract: BACKGROUND
  Research has shown that paranoia may directly build on negative ideas about the self. Feeling inferior can lead to ideas of vulnerability. The clinical prediction is that decreasing negative self cognitions will reduce paranoia.
  
  
  METHODS
  Thirty patients with persistent persecutory delusions were randomised to receive brief CBT in addition to standard care or to standard care (ISRCTN06118265). The six session intervention was designed to decrease negative, and increase positive, self cognitions. Assessments at baseline, 8 weeks (posttreatment) and 12 weeks were carried out by a rater blind to allocation. The primary outcomes were posttreatment scores for negative self beliefs and paranoia. Secondary outcomes were psychological well-being, positive beliefs about the self, persecutory delusions, social comparison, self-esteem, anxiety, and depression.
  
  
  RESULTS
  Trial recruitment and retention were feasible and the intervention highly acceptable to the patients. All patients provided follow-up data. Posttreatment there was a small reduction in negative self beliefs (Cohen's d=0.24) and a moderate reduction in paranoia (d=0.59), but these were not statistically significant. There were statistically significant improvements in psychological well-being (d=1.16), positive beliefs about the self (d=1.00), negative social comparison (d=0.88), self-esteem (d=0.62), and depression (d=0.68). No improvements were maintained. No adverse events were associated with the intervention.
  
  
  CONCLUSIONS
  The intervention produced short-term gains consistent with the prediction that improving cognitions about the self will reduce persecutory delusions. The improvement in psychological well-being is important in its own right. We recommend that the different elements of the intervention are tested separately and that the treatment is lengthened.
authors.affiliation: Department of Psychiatry, University of Oxford, UK. Electronic address: daniel.freeman@psych.ox.ac.uk.
authors.forename: Daniel
authors.initials: D
authors.lastname: Freeman
authors.affiliation: Sussex Partnership NHS Foundation Trust, UK.
authors.forename: Katherine
authors.initials: K
authors.lastname: Pugh
authors.affiliation: Centre for Biostatistics, Institute of Population Health, University of Manchester, UK; MRC NW Hub for Trials Methodology Research, UK.
authors.forename: Graham
authors.initials: G
authors.lastname: Dunn
authors.affiliation: Department of Psychiatry, University of Oxford, UK.
authors.forename: Nicole
authors.initials: N
authors.lastname: Evans
authors.affiliation: Department of Psychiatry, University of Oxford, UK.
authors.forename: Bryony
authors.initials: B
authors.lastname: Sheaves
authors.affiliation: Department of Psychiatry, University of Oxford, UK.
authors.forename: Felicity
authors.initials: F
authors.lastname: Waite
authors.affiliation: Department of Psychiatry, University of Oxford, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Cernis
authors.affiliation: Department of Psychiatry, University of Oxford, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Lister
authors.affiliation: Sussex Partnership NHS Foundation Trust, UK; Department of Psychology, University of Sussex, UK.
authors.forename: David
authors.initials: D
authors.lastname: Fowler
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003702:Delusions / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010259:Paranoid Disorders / Q000523:psychology / Q000628:therapy*; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000523:psychology / Q000628:therapy*; D012559:Schizophrenia / Q000628:therapy*; D012565:Schizophrenic Psychology; D012649:Self Concept; D057566:Self Report; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Clinical trial; Delusions; Paranoia; Self-esteem; Well-being