Feeling Safe Study

Compliance will be assessed by calculating the frequency of successful appointments from baseline to 6 months (end of therapy)

The number of drop-outs will be assessed by calculating the proportion of participants who do not complete the study protocol

Acceptability with the intervention will be assessed by an ad hoc questionnaire to measure the dimensions of acceptability: perceived utility, perceived ease of use, barriers, and intention to use

Satisfaction with the intervention will be assessed using the CSQ-8. A 4-point Likert scale is used to rate each item (1 = very dissatisfied; 4 = very satisfied), yielding a total score ranging from 8 to 32. A low score (close to 8) indicates low satisfaction with the services received, and a high score (close to 32) indicates high satisfaction with them.

The severity of psychotic symptoms will be assessed using the PANSS. This scale includes 30 items (7 for positive symptoms, 7 for negative symptoms, and 16 for general psychopathology). A 7-point Likert scale is used to rate each item (1 = not present; 7= most severe). The total score is the sum of all items. No specific cut-off scores have been established for the PANSS. The higher the score, the greater the clinical severity.

The severity of hallucinations and delusions will be assessed using the PSYRATS. It consists of two subscales, one for hallucinations and one for delusions, each with 17 items, with Likert-type responses ranging from 0 to 5. The final score is obtained by adding the scores for each item. It can range from 0 to 44. No specific cut-off scores have been established for the PSYRATS. The higher the score, the more severe the hallucinations/delusions.

The depression severity is assessed using the CDSS. This scale includes 9 items that are scored with a Likert scale that ranges from 0 (absent) to 3 (severe). The total score is the sum of all items. The higher the score, the greater the clinical severity. To identify the absence/presence of depression, a score ≥ 5 is the cut-off point.

Change in the delusional conviction severity will be assessed using the DC-VAS. This scale rates the degree of conviction of the delusional idea from 0 to 10.

The change in core beliefs will be assessed using the BCSS. This scale assesses an individual's core beliefs about themselves and others using a 5-point Likert scale (0-4). It comprises 24 items, yielding four scores: negative-self, positive-self, negative-others, and positive-others. Each score is based on six items. No specific cut-off scores have been established for the BCSS, scores are generally interpreted within a range. Higher scores generally indicate a greater endorsement of the beliefs represented by that subscale.

The safety behaviour severity will be assessed using the SBQ. This scale consists of 56 items rated on a 4-point Likert scale, where 0 = never and 3 = always. Specific cut-off scores haven't been established for the SBQ. Higher scores indicate greater frequency of use of safety behaviours.

The change in paranoid ideation will be assessed using the S-GPTS. This scale consists of a total of 32 items rated on a 5-point Likert scale from 1 (Not at all) to 5 (Completely). The items are grouped into two scales of 16 items. Scale A assesses social reference ideas relevant to paranoia, while Scale B assesses persecutory thoughts. Scores on each scale range from 16 to 80 points, with higher scores reflecting a greater level of paranoid thinking. No cut-off points have been established.

The change in functioning severity will be assessed using the PSP scale. The PSP scale evaluates four domains: Socially Useful Activities, Personal and Social Relationships, Self-Care, and Disturbing and Aggressive Behaviours. Each domain is rated on a 6-point severity scale, which is then converted into a 10-point band score for that domain. A total score is derived from the four domain scores, resulting in a single score between 1 and 100. No cut-off score is available. Higher scores indicate better functioning across all domains, with more severe functional difficulties reflected in lower scores.

The change in self-functionality will be assessed using the FAP-10. This questionnaire includes 10 items that are scored on a Likert scale ranging from 4 (Always) to 0 (Never). The total score is the sum of the scores for each item. The total score ranges from 0 (poor functionality) to 40 (excellent functionality).

The change in quality of life will be assessed using the QLI-sp. It is a 10-item questionnaire that assesses various aspects of health-related quality of life. It is scored on a scale of 1 to 10 points, with a higher score corresponding to a better quality of life. No cut-off scores are available.

The change in recovery will be assessed using the QPR. It is a 15-item scale. Each item is rated on a 5-point Likert scale, from 0 (strongly disagree) to 4 (strongly agree), and the items are added together to obtain a total recovery score. Higher scores indicate greater recovery. No cut-off scores are available.

The change in clinic insight will be assessed using the SUMD. It consists of three items that explore the degree of insight a person has into their mental disorder, the effects of medication, and the social consequences. Each item is scored from 0 to 5, where 0 indicates that the item is not relevant or cannot be assessed, and 5 indicates a lack of awareness. No cut-off points are available.

The change in cognitive insight will be assessed using the BCIS. The BCIS assesses cognitive insight, specifically self-reflectiveness and self-certainty, in individuals with psychosis. It's a 15-item self-report measure where participants rate their agreement with statements on a scale of 0 to 3. The BCIS yields two subscale scores (self-reflectiveness and self-certainty) and a composite Reflectiveness-Certainty (R-C) index score. The R-C index is calculated by subtracting the self-certainty score from the self-reflectiveness score. Higher R-C index scores indicate greater cognitive insight. Cut-off scores: low cognitive insight, scores of 3 and below; moderate cognitive insight, scores of 4 to 9; and high cognitive insight, scores of 10 and above.

Safety during the intervention will be assessed by collecting the presence of adverse events using an ad hoc clinical interview