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CompletedNCT04748679Updated Aug 15, 2024

Cognitive Behavioral Therapy (CBT) Study Evaluating the Updating of Persecutory Beliefs

An interventional study of Worry Intervention and Befriending in Schizophrenia; Psychosis and Persecutory Delusion, sponsored by Vanderbilt University Medical Center. Completed at 1 site in United States. Open to participants aged 18 Years to 65 Years. Per ClinicalTrials.gov, last updated 2024-08-15.

Sponsored by Vanderbilt University Medical Center · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
62
Allocation
Randomized
Ages
18 Years to 65 Years
Sex
All
01

Study summary

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.

02

Conditions studied

  • Schizophrenia; Psychosis
  • Persecutory Delusion
03

Who can participate

Ages eligible
18 Years to 65 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  1. Men and women age 18 - 65.
  2. Communicative in English.
  3. Premorbid Intelligence >79 (WTAR)
  4. Provide voluntary, written informed consent.
  5. Physically healthy by medical history.
  6. Weight \<300 lbs
  7. Stable medication regimen over at least the past two weeks, including the use of either an oral or intramuscular administration of an antipsychotic medication.
  8. Diagnosis of a non-affective psychotic disorder (schizophrenia, schizoaffective disorder, schizophreniform disorder, delusional disorder, brief psychotic disorder, psychosis NOS) confirmed by Structured Clinical Interview for Diagnostic and Statistical Manual (DSM)-5 (SCID) or diagnostic interview with a trained clinician.
  9. A persecutory delusion scoring at least a 3 on the conviction scale of the Psychotic Symptoms Rating Scale (PSYRATS) that had persisted for at least two weeks and that was not considered the direct result of substance use
  10. A clinically significant level of worry, as shown by a score of at least 44 on the Penn State Worry Questionnaire (PSWQ).

Exclusion criteria

Exclusion Criteria:

  1. Age less than 18 or greater than 65.
  2. Not communicative in English.
  3. Premorbid IQ \< 79 (WTAR)
  4. Unable to provide written informed consent.
  5. Current medical or neurological illness.
  6. History of severe head trauma.
  7. Weight >300 lbs
  8. Primary diagnosis of alcohol or substance use disorder or personality disorder
  9. Conditions that preclude fMRI scanning (as defined in the fMRI Screening Form)
  10. Subjects who are actively involved with individual cognitive therapy (Past experience with individual therapy is not an exclusion)
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Single (Outcomes assessor)
Enrollment
62 participants (actual)

Study arms

  • Experimental
    Worry Intervention

    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.

    Behavioral: Worry Intervention

  • Active comparator
    Befriending

    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.

    Behavioral: Befriending

Interventions

  • BehavioralWorry Intervention

    The worry intervention is weekly individual therapy with a trained therapist

  • BehavioralBefriending

    The worry intervention is weekly individual therapy with a trained therapist

05

What researchers measure

Primary outcomes

  1. Computational Parameters of Belief Updating as Measured During a Probabilistic Reversal Learning Task

    change in computational parameters after intervention

    Time frame: Baseline, 4 weeks, 8 weeks, 24 weeks

  2. 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.

    Time frame: Baseline, 4 weeks, 8 weeks, 24 weeks

  3. Change in Neural Correlates of Belief Updating Parameters

    Change in blood oxygen dependent level (BOLD) signal after intervention

    Time frame: Baseline, 8 weeks

Secondary outcomes

  1. Baseline Neural Predictors of Treatment Response

    BOLD signal during belief updating task at baseline predicting treatment response

    Time frame: Baseline

  2. Resting-State Predictors of Treatment Response

    resting-state connectivity of functional networks predicting treatment response

    Time frame: Baseline

06

Study locations

1 site
  • Vanderbilt University Medical Center
    Nashville, Tennessee 37212, United States
07

References and documents

Individual participant data

Plan to share: No

No publications or documents are linked to this record.

08

Registry details

Key details

Study ID
NCT04748679
Lead sponsor
Vanderbilt University Medical Center
Responsible party
Julia Sheffield (Assistant Professor of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center) — Principal investigator
First posted
Feb 10, 2021
Start date
Mar 30, 2021
Primary completion
May 29, 2024
Completion
May 29, 2024
Last update
Aug 15, 2024

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
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