ArticlePsychological medicine2025
A counterweight model for understanding and treating persecutory delusions.
Article in Psychological medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- A 6-month supported online program for the treatment of persecutory delusions: Feeling Safer.Psychological medicine · 2025Trial
- Patient expectations for outcome with psychological intervention for psychosis.Schizophrenia research · 2026Article
- An excitement building in the development of psychological treatments for schizophrenia.World psychiatry : official journal of the World Psychiatric Association (WPA) · 2026Article
- A review and integration of models on delusion maintenance.Psychological medicine · 2026Review
- Relating latent factors of reasoning, affect, and cognition to the delusional experience.Schizophrenia (Heidelberg, Germany) · 2026Article
- Helping Patients With Persecutory Delusions Find Safety.Schizophrenia bulletin · 2026Article
- Relational Therapies for People Who Hear Voices: Operationalisation and Current Status of an Emergent Group of Psychological Therapies.Schizophrenia bulletin · 2026Review
- Effects of Cognitive Behavioral Therapy for Worry Versus Befriending Therapy in Individuals with Persecutory Delusions: A Randomized Trial.Schizophrenia bulletin open · 2026Article
- Increasing physical activity and reducing sedentary behaviour in patients diagnosed with non-affective psychosis: a cross-sectional UK study identifying cognitions to target in treatment.EClinicalMedicine · 2025Article
- Are people noticing excessive mistrust in others and how do they understand it? A survey of a UK representative adult population.Psychological medicine · 2025Article
- Article
Corrections and comments
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Authors and funding
3 authors.
Funding
Abstract
Direct challenge seldom leads to change in strongly held beliefs such as persecutory delusions. A better route is to develop an alternative belief that can coexist with the delusion. The best such beliefs function as counterweights to the delusion. Over time, the scales shift. The alternative belief becomes more powerful than the delusion. In this paper, we set out such a model of persecutory delusions (or severe paranoia) and describe how it inherently translates theoretical understanding into treatment routes. Severe paranoia occurs when the adaptive cognitive processes of deciding whether to trust become overly weighted to mistrust. An inaccurate threat belief is formed, and the person feels very unsafe. Hence, overcoming the delusion means developing a counterweighting belief. It means building the alternative view that the world is safe enough for the person now and going forward. This, in turn, is done by
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.