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The Feeling Safe Programme: Animated Explainer

About the Feeling Safe Programme

The Feeling Safe Programme is a new cognitive-behavioural treatment for patients with psychosis. Developed with over a decade’s research, it is the most effective psychological treatment for persecutory delusions. Half of patients have recovery in their persecutory delusion with the Feeling Safe Programme. The main outcome randomised controlled trial is published in the Lancet Psychiatry.

The Feeling Safe Programme: Illustrated Explainer

To help people feel safer from persecutory delusions we have developed the Feeling Safe Programme. The culmination of 15 years of research and clinical practice and developed in conjunction with people with lived experience of the problem, Feeling Safe translates the best psychological science onto a ground-breaking cognitive treatment for persecutory delusions.
The Clinical Trial

130 Participants with medication resistant persecutory delusions

17-71 years age range

42 average age

Alternative text for image: Month view calendar pages with one date a month blocked out to represent appointments and the passing of time, and a line of people to represent patients.

Over 12 months

Compared Feeling Safe with Befriending Therapy


Over 20 sessions, the programme helps people develop new memories of safety and addresses the factors that often maintain persecutory thoughts – for example, worry, poor sleep, or low self-confidence.

Alternative text for image: The patient (identifiable as the patient by the red target they are standing on) has their head down and hands clasped, looking worried, whilst three people standing behind them (in grey scale) appear to be talking and gesticulating in the direction of the patient.


1: Patients choose their preferred treatment elements and the order of implementation.

Alternative text for image: A therapist is standing next to the patient guiding them to choose their preferred treatment elements. The treatment elements are represented as boxes on a touch screen wall. The elements/boxes the patient can choose from are ‘Winning Against Worry’, ‘Coping Better with Voices’, ‘Getting Better Sleep’, ‘Building Back Self-Confidence’, and ‘Feeling Safe Enough’. The patient is selecting ‘Building Back Self-Confidence’. There is a blue dashed line leading onto the next image/stage.


2: It’s an active therapy, based on the belief that people make gains by trying things out in everyday life.

Alternative text for image: The therapist guides the patient towards busy high street, there is a row of shops, shoppers on the pavement, and a red car on the road. The patient’s hands are still clasped but the outer ring of the red target they are standing on is fading. The therapist has a thought bubble of a pen and clipboard with a graph and lines to represent text. The thought bubble is labelled with the text – ‘Progress is monitored throughout the treatment process’. The blue dashed line continues, it becomes the central road markings.


3: The Feeling Safe Trial, published in the Lancet Psychiatry, shows that the programme is the most effective treatment for persecutory delusions.

Alternative text for image: The patient and therapist are on the pavement on other side of the high street, with the patient looking back towards the town and the Therapist looking and gesturing forwards, continuing to guide them to the next stage. The red target continues to fade.


4: Fifty percent of people experience large benefits from Feeling Safe, with a further quarter making moderate gains.

Alternative text for image: The blue dashed line continues, following an uphill path. The therapist stands on the path and waves at the patient as the patient goes on ahead and waves back. The red target fades further.


Alternative text for image: The blue dashed line and path come to an end at the top of the hill. There are trees and greenery. The patient stands with arms apart with yellow rays around their face, the red target now nearly completely faded. The patient is facing the three people who were behind them at the beginning, they are now in colour. The patient has a speech bubble “My life is so incredibly different now. I am in control of my life now – not my voices, not my paranoia and not my worry, but me.”


The Lancet Psychology logo

National Institute for Health Research logo

The Feeling Safe Programme logo

University of Oxford logo

Oxford Cognitive Approaches to Psychosis

Freeman et al (2021) lancet Psychology

Transcript for The Feeling Safe Programme Illustrated Explainer



Building on the success of the 2021 and 2022 courses, we are running the training for clinicians to deliver the Feeling Safe Programme again in 2023:

  • A five-day online course;
  • Therapy manuals provided;
  • And taught by Professor Daniel Freeman, Dr Felicity Waite, Dr Louise Isham, and Dr Rowan Diamond.

The course will be run 9.30am-5pm (UTC+1) on the following consecutive Thursdays: 5th October 2023, 12th October 2023, 19th October 2023, 26th October 2023, and 2nd November 2023.

Please note: The course is only open to clinicians.

How to book

Booking is now closed for The Feeling Safe Programme 5-day training course 2023.

For all queries please contact Ginny Evans at

The Feeling Safe Programme References

Theoretical rationale:

Freeman, D. (2016). Persecutory delusions: a cognitive perspective on understanding and treatment. Lancet Psychiatry, 3, 685-692.

Presence of causal factors:

Freeman, D., Taylor, K., Molodynski, A., & Waite, F. (2019). Treatable clinical intervention targets for patients with schizophrenia. Schizophrenia Research, 211, 44-50.


Freeman D, Dunn G, Startup H, Pugh K, Cordwell J, Mander H, Cernis, E., Wingham, G., Shirvell, K., & Kingdon, D. (2015) Effects of cognitive behaviour therapy for worry on persecutory delusions in patients with psychosis (WIT): a parallel, single-blind, randomised controlled trial with a mediation analysis. Lancet Psychiatry, 2, 305-313.

Negative beliefs about self:

Freeman, D., Pugh, K., Dunn, G., Evans, N., Sheaves, B., Waite, F., Cernis, E., Lister, R., & Fowler, D. (2014). An early Phase II randomised controlled trial testing the effect on persecutory delusions of using CBT to reduce negative cognitions about the self: the potential benefits of enhancing self confidence. Schizophrenia Research, 160, 186-192.

Sleep dysfunction:

Freeman, D., Waite, F., Startup, H., Myers, E., Lister, E., McInerney, J., Harvey, A., Geddes, J., Zaiwalla, Z., Luengo-Fernandez, R., Foster, R., Clifton, L, & Yu, L-M. (2015). Efficacy of cognitive behavioural therapy for sleep improvement in patients with persistent delusions and hallucinations (BEST): a prospective, assessor-blind, randomised controlled pilot study. Lancet Psychiatry, 2, 975-983.

Waite, F., Myers, E., Harvey, A., Espie, C., Startup, H., Sheaves, B., & Freeman, D. (2016). Treating sleep problems in patients with schizophrenia. Behavioural and Cognitive Psychotherapy, 44, 273-287. 

Freeman, D., Sheaves, B., Goodwin, G., Yu, L-M., Nickless, A., Harrison, P., Emsley, R., Luik, A., Foster, R., Wadekar, V., Hinds, C., Gumley, A., Jones, R., Lightman, S., Jones, S., Bentall, R., Kinderman, P., Rowse, G., Brugha, T., Blagrove, M., Gregory, A., Fleming, L., Walklet, E., Glazebrook, Davies, E., Hollis, C., Haddock, G., John, B., Coulson, M., Fowler, D., Pugh, K., Cape, J., Mosely, P., Brown, G., Hughes, C., Obonsawin, M., Coker, S., Watkins, E., Schwannauer, M., MacMahon, K., Siriwaardena, A., Espie, C. (2017). The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis. Lancet Psychiatry, 4, 749-758.  

Defence behaviours:

Freeman, D., Bradley, J., Antley, A., Bourke, E., DeWeever, N., Evans, N., Černis, E., Sheaves, B., Waite, F., Dunn, G., Slater, M., & Clark, D. (2016). Virtual reality in the treatment of persecutory delusions.: a randomised controlled experimental study testing how to reduce delusional conviction. British Journal of Psychiatry, 209, 62-67.

Full treatment case series:

Freeman, D., Bradley, J., Waite, F., Sheaves, B., DeWeever, N., Bourke, E., McInerney, J., Evans, N., Černis, E., Lister, R., Garety, P. & Dunn, G. (2016). Targeting recovery in persistent persecutory delusions: a proof of principle study of a new translational psychological treatment. Behavioural and Cognitive Psychotherapy, 44, 539-552.

Randomised controlled trial:

Freeman, D., Emsley, R., Diamond, R., Collett, N., Bold, E., Chadwick, E., Isham, L., Bird, J., Edwards, D., Kingdon, D., Fitzpatrick, R., Kabir, T., Waite, F., & Oxford Cognitive Approaches to Psychosis Trial Study Group (2021). Comparison of a theoretically driven cognitive therapy (the Feeling Safe Programme) with befriending for the treatment of persistent persecutory delusions: a parallel, single-blind, randomised controlled trial. Lancet Psychiatry.  

Course Presenters