title: Thinking Well: A randomised controlled feasibility study of a new CBT therapy targeting reasoning biases in people with distressing persecutory delusional beliefs.
abstract: OBJECTIVE
  Delusional beliefs with persecutory content are common in psychosis, but difficult to treat. Interventions targeting hypothesised causal and maintaining factors have been proposed as a way of improving therapy. The current study is a feasibility randomised controlled trial of the 'Thinking Well (TW)' intervention: This novel approach combines the recently developed Maudsley Review Training Programme (MRTP), with additional, focussed cognitive-behavioural therapy sessions.
  
  
  METHODS
  31 participants with distressing persecutory delusions and schizophrenia spectrum disorders were randomised to TW or to treatment as usual in a 2:1 ratio. Participants completed outcome assessments at 0 (baseline), 1 (post-MRTP), 6 (post-TW) and 8 (follow-up) weeks. Key outcomes included belief flexibility, paranoia, and delusional conviction and distress. Participants allocated to TW completed the MRTP package and four CBT sessions with a clinical psychologist.
  
  
  RESULTS
  Recruitment proved feasible. Participants reported the intervention was relevant and had resulted in positive changes in thinking and mood, which they could use in everyday life. Treatment effects were moderate-large for key outcomes including belief flexibility, paranoia conviction and distress. The additional TW sessions appeared to confer benefits over MRTP alone.
  
  
  CONCLUSIONS
  Assessments were not carried out blind to treatment condition. Recruitment was opportunistic, from an identified pool of research participants. Finally, a few participants had already completed the MRTP as part of a previous study.
  
  
  CONCLUSIONS
  The TW intervention appears to be feasible and acceptable to participants, and the effects of treatment are promising. A fully powered randomised controlled trial of the intervention is warranted.
authors.affiliation: King's College London, The Institute of Psychiatry, Psychology & Neuroscience, UK. Electronic address: helen.waller@kcl.ac.uk.
authors.forename: Helen
authors.initials: H
authors.lastname: Waller
authors.affiliation: Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester Academic Health Science Centre, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Emsley
authors.affiliation: Department of Psychiatry, Oxford University, Oxford, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Freeman
authors.affiliation: Mental Health Sciences Unit, Faculty of Brain Sciences, University College London, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Bebbington
authors.affiliation: Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester Academic Health Science Centre, UK.
authors.forename: Graham
authors.initials: G
authors.lastname: Dunn
authors.affiliation: Department of Psychology, University of Sussex, Brighton, UK.
authors.forename: David
authors.initials: D
authors.lastname: Fowler
authors.affiliation: King's College London, The Institute of Psychiatry, Psychology & Neuroscience, UK.
authors.forename: Amy
authors.initials: A
authors.lastname: Hardy
authors.affiliation: King's College London, The Institute of Psychiatry, Psychology & Neuroscience, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kuipers
authors.affiliation: King's College London, The Institute of Psychiatry, Psychology & Neuroscience, UK.
authors.forename: Philippa
authors.initials: P
authors.lastname: Garety
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003702:Delusions / Q000209:etiology / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010259:Paranoid Disorders / Q000209:etiology / Q000628:therapy*; D010865:Pilot Projects; D011618:Psychotic Disorders / Q000150:complications / Q000628:therapy*; D013850:Thinking
keywords: Belief flexibility; CBT; Psychosis; Reasoning