Prior Expectations of Volatility Following Psychotherapy for Delusions Article Swipe
Julia M. Sheffield
,
Ali Frances Sloan
,
Philip R. Corlett
,
Baxter P. Rogers
,
Simon Vandekar
,
Jinyuan Liu
,
Kendall Beals
,
Lauren M. Hall
,
Taylor Gautier
,
Alexandra B. Moussa‐Tooks
,
Lénie Torregrossa
,
Margaret Achee
,
Kristan Armstrong
,
Neil D. Woodward
,
Kaylee Belt
,
Daniel Freeman
,
Louise Isham
,
Rowan Diamond
,
Aaron P. Brinen
,
Stephan Heckers
·
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1001/jamanetworkopen.2025.17132
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1001/jamanetworkopen.2025.17132
Importance Persecutory delusions are common, distressing, and difficult to treat. Testing computational neuroscience models of delusions can identify new therapeutic targets. Objective To determine whether change in delusion severity is associated with a corresponding change in volatility priors and brain activation estimated during a belief updating task. Design, Setting, and Participants This randomized clinical trial was conducted from April 9, 2021, to December 5, 2023, within the Vanderbilt University Medical Center Psychiatric Hospital and at a community mental health center in Nashville, Tennessee. Participants were adults (aged between 18 and 65 years) with schizophrenia spectrum or delusional disorder and an active, persistent (≥3 months) persecutory delusion with strong conviction (>50%). Participants were randomly assigned 1:1 to either cognitive behavioral therapy for psychosis (CBTp)–based intervention or befriending therapy. Intention-to-treat analysis was performed from June 1 to October 31, 2024. Intervention The CBTp was a manualized intervention targeting persecutory delusions. The befriending therapy involved engaging in conversations and activities focused on neutral topics. Both interventions were provided in person, lasted for 8 weeks, and included standard care. Standard care consisted of medication management and ancillary services. Main Outcomes and Measures Primary outcomes were volatility priors (ie, prior expectations of volatility) derived from a 3-option probabilistic reversal learning task; persecutory delusion severity measured by the Psychotic Symptom Rating Scales (PSYRATS delusion subscale; score range: 0-16, with the highest score indicating severe preoccupation, distress, conviction, and functioning impact); and brain activation in the striatum and prefrontal cortex measured by blood oxygenation level–dependent signal change. Associations between volatility priors, clinical improvement, and change in neural activation were examined. Results Sixty-two participants (median [range] age, 31 [19-63] years; 38 males [61%]) were randomly assigned to the CBTp (n = 32) or befriending therapy (n = 30) arms. A subgroup of 35 participants (57%) completed functional magnetic resonance imaging. Volatility priors decreased following treatment ( F 1,112 = 7.7 [ P = .006]; Cohen d = 0.52 [95% CI, 0.15-0.90]), as did delusion severity ( F 1,112 = 59.7 [ P < .001]; Cohen d = 1.50 [95% CI, 1.00-1.90]), across both groups. The decrease in volatility priors was not associated with clinical improvement in PSYRATS scores ( F 1,102.8 = 1.8 [ P = .18]; Cohen d = 0.26 [95% CI, –0.12 to 0.65]). Activation in the caudate and prefrontal cortex significantly decreased following treatment. Decreased caudate activation was associated with decreased volatility priors ( F 1,58.3 = 16.6 [ P < .001]; Cohen d = 1.07 [95% CI, 0.51-1.61]) but not with PSYRATS total scores. Associations remained significant after controlling for antipsychotic medication ( F 1,53 = 13.77; P < .001). Conclusions and Relevance This randomized clinical trial found that elevated volatility priors and associated activation in the caudate nucleus were amenable to change. Volatility priors could be a potential target for intervention in psychosis. Trial Registration ClinicalTrials.gov Identifier: NCT04748679
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1001/jamanetworkopen.2025.17132
- https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2835518/sheffield_2025_oi_250542_1749749046.73041.pdf
- OA Status
- gold
- References
- 62
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4411582163
All OpenAlex metadata
Raw OpenAlex JSON
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https://openalex.org/W4411582163Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1001/jamanetworkopen.2025.17132Digital Object Identifier
- Title
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Prior Expectations of Volatility Following Psychotherapy for DelusionsWork title
- Type
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articleOpenAlex work type
- Language
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enPrimary language
- Publication year
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2025Year of publication
- Publication date
-
2025-06-24Full publication date if available
- Authors
-
Julia M. Sheffield, Ali Frances Sloan, Philip R. Corlett, Baxter P. Rogers, Simon Vandekar, Jinyuan Liu, Kendall Beals, Lauren M. Hall, Taylor Gautier, Alexandra B. Moussa‐Tooks, Lénie Torregrossa, Margaret Achee, Kristan Armstrong, Neil D. Woodward, Kaylee Belt, Daniel Freeman, Louise Isham, Rowan Diamond, Aaron P. Brinen, Stephan HeckersList of authors in order
- Landing page
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https://doi.org/10.1001/jamanetworkopen.2025.17132Publisher landing page
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https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2835518/sheffield_2025_oi_250542_1749749046.73041.pdfDirect link to full text PDF
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YesWhether a free full text is available
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goldOpen access status per OpenAlex
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https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2835518/sheffield_2025_oi_250542_1749749046.73041.pdfDirect OA link when available
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Psychotherapist, Volatility (finance), Psychology, Economics, Financial economicsTop concepts (fields/topics) attached by OpenAlex
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0Total citation count in OpenAlex
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62Number of works referenced by this work
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10Other works algorithmically related by OpenAlex
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