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The purpose of this study is to examine how Bayesian belief updating changes throughout psychotherapeutic treatment for persecutory delusions. Specifically, individuals with a psychotic disorder diagnosis who endorse both a current persecutory delusion with strong conviction and significant worry will be recruited and randomized to receive either a CBT-based worry intervention for persecutory delusions or an active control condition (befriending therapy). The investigators will examine: 1) whether belief updating parameters change as delusion severity changes, 2) whether CBT contributes to greater change in belief updating parameters than befriending therapy, and 3) whether neural correlates of belief updating parameters, as measured using functional magnetic resonance imaging (fMRI), predict treatment response.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Worry Intervention | Experimental | The Worry Intervention uses cognitive-behavioral therapy (CBT) techniques to support the patient in reducing the amount of time they worry throughout the week. It is an 8-week manualized treatment with 5 modules. Each session is 45-60 minutes. |
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| Befriending | Active Comparator | Befriending therapy controls for the general factors of therapy (warmth, engagement) without any 'active' interventions. Individuals in the befriending arm will spend sessions talking with the therapist about things that interest them. It will also be conducted over 8-weeks with 45-60 minute sessions. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Worry Intervention | Behavioral | The worry intervention is weekly individual therapy with a trained therapist |
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| Measure | Description | Time Frame |
|---|---|---|
| Computational Parameters of Belief Updating as Measured During a Probabilistic Reversal Learning Task | change in computational parameters after intervention | Baseline, 4 weeks, 8 weeks, 24 weeks |
| Change in Delusion Severity Utilizing the Change in Psychotic Symptoms Rating Scale (PSYRATS) | The change in the Delusions subscale total of the Psychotic Symptoms Rating Scale (PSYRATS) from Baseline to Week 24. The Delusions subscale is a composite score of 6 items each rated from 0-4 with 4 indicating more severe symptomology. The Delusions subscale has a possible range of 0-24. | Baseline, 4 weeks, 8 weeks, 24 weeks |
| Change in Neural Correlates of Belief Updating Parameters | Change in blood oxygen dependent level (BOLD) signal after intervention | Baseline, 8 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Baseline Neural Predictors of Treatment Response | BOLD signal during belief updating task at baseline predicting treatment response | Baseline |
| Resting-State Predictors of Treatment Response | resting-state connectivity of functional networks predicting treatment response |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Vanderbilt University Medical Center | Nashville | Tennessee | 37212 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40553472 | Derived | Sheffield JM, Sloan AF, Corlett PR, Rogers BP, Vandekar S, Liu J, Beals KM, Hall LM, Gautier T, Moussa-Tooks AB, Torregrossa LJ, Achee M, Armstrong K, Woodward ND, Belt K, Freeman D, Isham L, Diamond R, Brinen AP, Heckers S. Prior Expectations of Volatility Following Psychotherapy for Delusions: A Randomized Clinical Trial. JAMA Netw Open. 2025 Jun 2;8(6):e2517132. doi: 10.1001/jamanetworkopen.2025.17132. |
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| ID | Term |
|---|---|
| D012559 | Schizophrenia |
| D011618 | Psychotic Disorders |
| ID | Term |
|---|---|
| D019967 | Schizophrenia Spectrum and Other Psychotic Disorders |
| D001523 | Mental Disorders |
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| Befriending | Behavioral | The worry intervention is weekly individual therapy with a trained therapist |
|
| Baseline |