Feeling Safe is fundamentally an effort to counteract and supersede memories of danger by helping the person to relearn that they are safe. To do that, we need to tackle first the key maintenance factors. We help people, for example, worry less, sleep better, and feel more self-confident. Then, ultimately, it’s about spending time in the feared situations with one’s defences lowered, fully engaged in the moment and experience. By so doing, the person can learn that they are, in fact, safe.
Does it work? The results of the first randomised controlled clinical trial of Feeling Safe have just been published in The Lancet Psychiatry. Taking part were 130 patients with persistent persecutory delusions, recruited from NHS mental health services. The form of the trial was intentionally tough: we compared the Feeling Safe Programme to an alternative psychological approach provided by the same therapists. In this way, we could tell if the Feeling Safe programme brings benefits beyond those that come with a positive therapeutic relationship. Patients were assessed before treatment (which typically comprised twenty sessions over a six-month period), after treatment, and six months later.
The results have been as good as I had dared to imagine all those years back. Half of patients at the end of treatment no longer had a persecutory delusion. A further quarter experienced moderate benefit. And those gains largely remained at follow up. Feeling Safe did not only tackle paranoia; it also brought an improvement in patients’ general psychological wellbeing. Crucially, the treatment was very popular: almost everyone stayed the course. Feeling Safe showed large benefits compared to the alternative (and often effective) psychological treatment. The type of therapy we provide to patients really does matter.