We’ve all felt unsafe at some point – walking alone at night, hearing an unexpected noise at home, or facing an uncertain situation.
But for some people, particularly those experiencing schizophrenia-related symptoms like paranoia or hearing voices, that fearful feeling doesn’t always pass. It shapes their perception of the world, limiting their ability to engage in everyday life.
At The Royal, the Feeling Safe program is changing that. Based on 15 years of research from Oxford University, this innovative cognitive behavioural therapy (CBT) program helps individuals gradually regain their sense of security and confidence. Instead of directly challenging beliefs, it focuses on behavioural strategies that help people reduce their fear and reclaim their independence.
The Royal was the first mental health care organization in Canada to offer Feeling Safe and the only one researching its effectiveness in a group setting.
How feeling safe works
Feeling Safe is used alongside other treatments, such as medication, to enhance overall well-being. It is not a replacement, but rather, a complementary approach that provides practical psychological support.
“Seventy-five percent of people who take this program get better; that’s huge,” says Lisa Murata, a clinical nurse specialist with The Royal’s Schizophrenia Program working in the Regional Psychosis Clinic. “Half get a lot better, a quarter make some gains, and for the others, there isn’t really any change.”
Murata describes the success rate as “mind-blowing,” especially compared to standard treatment.
The program consists of five modules and participants choose which areas they want to focus on: Winning Against Worry, Boosting Self-Confidence, Getting Better Sleep, Feeling Safe Alongside Hearing Voices, and Feeling Safe Enough.
For many participants, the Feeling Safe program opens doors they once thought were permanently closed.
“Imagine being afraid to go to the grocery store,” says Murata. “Not going to school, work, or even the gym can make a person’s world much smaller.”
Just stepping outside can be overwhelming for people who feel like they are constantly being followed or watched. Dr. Alexandra Baines, a psychiatrist at The Royal working closely with Murata on the Feeling Safe program, emphasizes how deeply paranoia can affect daily life.
“People become demoralized over time because the voices they hear erode their self-confidence,” she explains. “They’re always questioning, debating, and critiquing their decisions, which makes it hard to trust their own judgment.”
What is CBT for psychosis?
CBT is a widely used, evidence-based therapy that helps people manage mental health challenges by identifying and reshaping unhelpful thought patterns. It teaches individuals how their thoughts, emotions, and behaviours are connected and how making small shifts can significantly improve their mental health.
Feeling Safe is a specialized form of CBT tailored for people with schizophrenia or psychosis. Rather than disputing whether a person’s delusions are real, the program focuses on gradual exposure to fears and building coping skills.
“We talk about whether we are safe enough,” says Murata. “The general idea is to prove that sense of autonomy, self-confidence and belief in yourself.”
A unique group approach
One standout feature of the Feeling Safe program at The Royal is the way it’s run: clinicians participate alongside attendees.
By openly sharing their strategies for managing worry and sleep difficulties, clinicians create a collaborative atmosphere of mutual understanding. This helps normalize participants' experiences and encourages them to open up, ask questions, and practice new strategies in a supportive space.
Bridging research and care
Initially designed as a one-on-one therapy, Feeling Safe was brought to The Royal by Murata after attending a conference session led by Dr. Daniel Freeman, a renowned psychologist based in the UK.
The first module, focusing on sleep, was delivered virtually during the COVID-19 pandemic. Client feedback was positive, solidifying Murata’s belief that the program should become a part of The Royal’s offerings.
Since then, Murata, Baines, Dr. Deanna Mercer and their team have received funding to research Feeling Safe in a group setting at The Royal. They are comparing wait-listed participants’ outcomes to those who start in the group who are not wait-listed to see the effectiveness of group delivery. The study is the first of its kind to examine group delivery of Feeling Safe. Recruitment is ongoing and should be completed in the fall of 2027.
Looking ahead: A North American centre of expertise
The team is keen to see The Royal become North America’s centre of expertise for Feeling Safe. They are teaching other therapists in partnership with Freeman’s University of Oxford team to expand treatment capacity and train more clinicians to provide Feeling Safe, locally and beyond.
“Part of our goal is to share knowledge on how to deliver this program and increase clinical expertise in CBT for psychosis,” says Baines. “We want to build a sustainable program with ongoing staff training so that Feeling Safe remains a long-term offering at The Royal.”
By expanding access to Feeling Safe, The Royal is improving care for its clients and leading the way in Canada for innovative and effective treatments.
“Feeling Safe is a powerful example of how research informs care at The Royal,” says Dr. Florence Dzierszinski, president of the University of Ottawa Institute of Mental Health Research and vice-president of research at The Royal. “Research is care. By integrating evidence into real-world treatment, we’re transforming lives and advancing mental health care.”
About The Royal
The Royal is one of Canada’s foremost mental illness and addiction treatment, research, and education hospitals, dedicated to supporting individuals aged 16 and older who are living with complex mental illness and addiction. Since opening in 1910, The Royal has grown into a trusted resource for people across eastern and northern Ontario, western Quebec, and Nunavut.
With campuses in Ottawa and Brockville, and clinical teams working directly in homes and communities, The Royal delivers compassionate, evidence-informed care grounded in cutting-edge research, including through its partnership with the University of Ottawa and other academic and community partners. Its integrated model brings together care, research, education, and strategic partnerships to help build a future of recovery.
At The Royal, we separate the person from the illness, helping more people reclaim their lives.
Media contact
Alyssa Nader, Communications Specialist, The Royal, anader@theroyal.ca.
