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Professor Daniel Freeman, clinical psychologist, explains how delusions may be unfounded but they cause real distress and misery for sufferers - who feel constantly unsafe. He set himself the challenge of finding an effective treatment, a decade later he and colleagues have unveiled Feeling Safe, which shows real benefits for trial participants and, he hopes, a step change in the treatment of severe paranoia.

Professor Daniel Freeman
'I was too paranoid about going out. Thinking someone's going to stab me. I was housebound. Purely just paranoia. I missed out on so many things in life. I'd lie in bed, and I'd be thinking that tomorrow something's going to happen, something's going to happen. It would play on my mind 24/7.'

This fear of other people is common among people diagnosed with severe mental health disorders such as schizophrenia. Largely unfounded, often unrelenting, and wearyingly upsetting, these intensely paranoid thoughts are known as persecutory delusions. People feel very unsafe. Also typical is the response: when being out and about is so frightening, staying at home can seem the only way to cope. But there are consequences for both mental and physical health. For example, three quarters of patients with severe paranoia have suicidal thoughts. Life expectancy is on average 14.5 years shorter, due to conditions such as high blood pressure, diabetes and heart disease - illnesses to which inactivity is likely a significant contributory factor.

Given the distress caused by persecutory delusions, treatment is critically important. Usually, people are prescribed anti-psychotic medications. They certainly can help, but only about a quarter of patients have a good response. Moreover, these drugs can trigger unwelcome side-effects. Sometimes medication is combined with psychological treatment – specifically something called cognitive behaviour therapy (CBT) for psychosis. Again, some people get real additional benefit, but all too often the paranoia persists.

There has been, then, plenty of scope for improvement in the treatment of persecutory delusions. So, I set myself an ambitious target: to produce a psychological therapy that would lead to recovery in persecutory delusions for 50% of patients for whom anti-psychotic medication had not succeeded. That half of patients would no longer believe that their fears were true. The Feeling Safe programme, developed with colleagues over the past decade, is the result of that effort.

Read the full story on the University of Oxford website.

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