Changing expectations did not clearly track improvement in persecutory delusions
Delusion severity decreased across both psychotherapy groups. Expectations about how changeable situations are also decreased, but those changes were not clearly linked to clinical improvement.
Based on the published abstract. The full paper may contain additional methods, results and limitations.
The 30-second takeaway
Delusion severity and task-derived expectations about change decreased across both therapy groups. However, the study did not establish that changes in those expectations tracked clinical improvement. Reduced caudate activity tracked expectation changes, but no association with overall delusion scores was detected, leaving the proposed target's clinical relevance uncertain.
The abstract does not report superiority of either therapy, and both included standard care. Brain imaging involved a subgroup, limiting interpretation of the proposed brain-based target.
What researchers found
Expectation changes and delusion improvement
Across both therapy groups after 8 weeks, changes in task-derived expectations were not significantly associated with improvement in PSYRATS delusion severity scores.
What the expectation measure means
Researchers estimated prior expectations of volatility: how changeable participants expected a situation to be. This measure came from a belief-updating task, while clinical improvement was assessed separately using a scale of delusion severity.
Brain changes and clinical changes
Scans in a subgroup showed reduced activity in the caudate and prefrontal cortex after treatment. Reduced caudate activity was associated with changing expectations, but an association with overall delusion severity scores was not detected.
The original publication
Prior Expectations of Volatility Following Psychotherapy for Delusions: A Randomized Clinical Trial.
Sheffield JM, Sloan AF, Corlett PR et al.
JAMA Netw Open · 2025
- PubMed ID
- 40553472
- Record checked
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