{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:24:10Z","timestamp":1785403450210,"version":"3.56.0"},"reference-count":129,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:00:00Z","timestamp":1777939200000},"content-version":"unspecified","delay-in-days":124,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Psychol. Med."],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Contemporary definitions of delusions highlight their resistance to conflicting evidence as the core feature. However, most etiological models of delusions have focused on delusion formation rather than maintenance and we lack a coherent understanding of why delusions persist. We conducted a systematic literature search of models on delusion maintenance, extracted their core postulates, point to explanatory gaps, and derive an integrated framework. We identified 74 published accounts that include postulated mechanisms of delusion maintenance. We classified the models into six core perspectives that informed them: Bayesian inference (17 models), associative learning theory (6 models), neurobiological (11 models), cognitive\u2013behavioral (23 models), motivational (7 models), and social (6 models). Most models highlight a mechanistic role of avoidance and operant learning, converging on the idea that a delusional explanation is reinforced. Another repeatedly suggested mechanism is that the delusional belief, once formed, influences the way further information is processed. In addition, most models propose a key role of individual deficits and biases. The proposed factors can be combined in temporal progression, including early risk factors and resulting vulnerability, the common proposed mechanism of formation (i.e. search for explanation of ambiguous experiences), and the short- and long-term consequences of the delusional explanation along with feedback loops. By considering numerous factors and their interactions, the integrative model provides a considerably more compelling account of why delusions persist than any single perspective alone. It can help to identify novel directions for research and intervention, such as addressing short-term benefits of delusion maintenance.<\/jats:p>","DOI":"10.1017\/s0033291726103705","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T09:01:38Z","timestamp":1777971698000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["A review and integration of models on delusion maintenance"],"prefix":"10.1017","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6674-2440","authenticated-orcid":false,"given":"Tania M.","family":"Lincoln","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00g30e956","id-type":"ROR","asserted-by":"publisher"}],"name":"Universit\u00e4t Hamburg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8944-0412","authenticated-orcid":false,"given":"Henning","family":"Romberg","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00g30e956","id-type":"ROR","asserted-by":"publisher"}],"name":"Universit\u00e4t Hamburg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0222-7770","authenticated-orcid":false,"given":"David","family":"Torrents-Rodas","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00g30e956","id-type":"ROR","asserted-by":"publisher"}],"name":"Universit\u00e4t Hamburg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4670-2844","authenticated-orcid":false,"given":"Antonia","family":"Bott","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00g30e956","id-type":"ROR","asserted-by":"publisher"}],"name":"Universit\u00e4t Hamburg"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,5,5]]},"reference":[{"key":"S0033291726103705_r44","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pcbi.1000211"},{"key":"S0033291726103705_r80","doi-asserted-by":"publisher","DOI":"10.1093\/schizbullopen\/sgac033"},{"key":"S0033291726103705_r5","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.112.119032"},{"key":"S0033291726103705_r90","doi-asserted-by":"publisher","DOI":"10.1016\/j.tics.2024.09.011"},{"key":"S0033291726103705_r81","doi-asserted-by":"publisher","DOI":"10.1016\/j.concog.2007.01.003"},{"key":"S0033291726103705_r122","first-page":"33","volume-title":"The social psychology of intergroup relations","author":"Tajfel","year":"1979"},{"key":"S0033291726103705_r28","doi-asserted-by":"publisher","DOI":"10.1016\/j.cobeha.2016.04.001"},{"key":"S0033291726103705_r13","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2019.101748"},{"key":"S0033291726103705_r41","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-019-3198-6"},{"key":"S0033291726103705_r19","doi-asserted-by":"publisher","DOI":"10.1080\/17470210701338071"},{"key":"S0033291726103705_r126","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2017.08.045"},{"key":"S0033291726103705_r128","doi-asserted-by":"publisher","DOI":"10.1007\/s11097-010-9168-9"},{"key":"S0033291726103705_r108","doi-asserted-by":"publisher","DOI":"10.1007\/s00406-010-0101-6"},{"key":"S0033291726103705_r69","doi-asserted-by":"publisher","DOI":"10.1038\/s41537-025-00577-2"},{"key":"S0033291726103705_r130","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"S0033291726103705_r46","doi-asserted-by":"publisher","DOI":"10.4236\/psych.2013.49102"},{"key":"S0033291726103705_r94","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.psych.52.1.111"},{"key":"S0033291726103705_r101","doi-asserted-by":"publisher","DOI":"10.1111\/j.1751-7893.2010.00190.x"},{"key":"S0033291726103705_r105","doi-asserted-by":"publisher","DOI":"10.1080\/13546805.2021.1982686"},{"key":"S0033291726103705_r29","doi-asserted-by":"publisher","DOI":"10.1038\/s41380-019-0427-z"},{"key":"S0033291726103705_r2","volume-title":"Diagnostic and statistical manual of mental disorders, text revision DSM-5-TR","year":"2022"},{"key":"S0033291726103705_r20","doi-asserted-by":"publisher","DOI":"10.1080\/13546800903439120"},{"key":"S0033291726103705_r88","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2024.07.021"},{"key":"S0033291726103705_r82","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2015.01450"},{"key":"S0033291726103705_r92","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbae225"},{"key":"S0033291726103705_r72","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2022.814111"},{"key":"S0033291726103705_r33","doi-asserted-by":"publisher","DOI":"10.1038\/nrn2536"},{"key":"S0033291726103705_r38","doi-asserted-by":"publisher","DOI":"10.1017\/S003329170100455X"},{"key":"S0033291726103705_r73","doi-asserted-by":"publisher","DOI":"10.1016\/j.comppsych.2013.03.002"},{"key":"S0033291726103705_r17","first-page":"1167","article-title":"Using unobserved causes to explain unexpected outcomes: The effect of existing causal knowledge on protection from extinction by a hidden cause","volume":"50","author":"Chow","year":"2024","journal-title":"Journal of Experimental Psychology: Learning, Memory, and Cognition"},{"key":"S0033291726103705_r115","doi-asserted-by":"publisher","DOI":"10.3758\/s13423-022-02173-2"},{"key":"S0033291726103705_r26","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2024.102510"},{"key":"S0033291726103705_r12","doi-asserted-by":"publisher","DOI":"10.1080\/13546800903442314"},{"key":"S0033291726103705_r118","first-page":"151","article-title":"Theory protection in associative learning: Humans maintain certain beliefs in a manner that violates prediction error","volume":"46","author":"Spicer","year":"2020","journal-title":"Journal of Experimental Psychology: Animal Learning and Cognition"},{"key":"S0033291726103705_r85","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbtep.2016.07.004"},{"key":"S0033291726103705_r121","doi-asserted-by":"publisher","DOI":"10.1186\/1471-244X-12-193"},{"key":"S0033291726103705_r11","doi-asserted-by":"publisher","DOI":"10.5040\/9781350163331"},{"key":"S0033291726103705_r37","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-014-0928-7"},{"key":"S0033291726103705_r70","volume-title":"Thinking, fast and slow","author":"Kahneman","year":"2012"},{"key":"S0033291726103705_r96","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbad084"},{"key":"S0033291726103705_r63","doi-asserted-by":"publisher","DOI":"10.1016\/0883-9417(90)90006-7"},{"key":"S0033291726103705_r102","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2020.2304"},{"key":"S0033291726103705_r111","doi-asserted-by":"publisher","DOI":"10.1002\/cpp.746"},{"key":"S0033291726103705_r50","first-page":"29","article-title":"Links between trauma and psychotic symptoms: Integrating cognitive behavioural and neuropsychoanalytic models of psychosis","volume":"9","author":"Garrett","year":"2025","journal-title":"Garrett\u2014Psychology and Psychotherapy: Theory, Research and Practice\u2014Wiley Online Library"},{"key":"S0033291726103705_r59","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2021.08.025"},{"key":"S0033291726103705_r32","doi-asserted-by":"publisher","DOI":"10.1080\/13546805.2015.1136206"},{"key":"S0033291726103705_r3","doi-asserted-by":"publisher","DOI":"10.1016\/j.comppsych.2004.06.001"},{"key":"S0033291726103705_r76","doi-asserted-by":"publisher","DOI":"10.1006\/jmps.2000.1354"},{"key":"S0033291726103705_r117","doi-asserted-by":"publisher","DOI":"10.1016\/j.mehy.2007.11.017"},{"key":"S0033291726103705_r21","doi-asserted-by":"publisher","DOI":"10.1177\/0269881116650087"},{"key":"S0033291726103705_r125","doi-asserted-by":"publisher","DOI":"10.1080\/00332747.1992.11024582"},{"key":"S0033291726103705_r25","first-page":"143","article-title":"Effects of context on responding during a compound stimulus","volume":"21","author":"Darby","year":"1995","journal-title":"Journal of Experimental Psychology: Animal Behavior Processes"},{"key":"S0033291726103705_r119","doi-asserted-by":"publisher","DOI":"10.1016\/S0010-440X(95)90103-5"},{"key":"S0033291726103705_r91","doi-asserted-by":"publisher","DOI":"10.1177\/17456916221148147"},{"key":"S0033291726103705_r18","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2023.102303"},{"key":"S0033291726103705_r35","doi-asserted-by":"publisher","DOI":"10.1097\/01.nmd.0000161687.12931.67"},{"key":"S0033291726103705_r22","doi-asserted-by":"publisher","DOI":"10.3389\/neuro.09.012.2009"},{"key":"S0033291726103705_r9","doi-asserted-by":"publisher","DOI":"10.1016\/S0272-7358(01)00106-4"},{"key":"S0033291726103705_r67","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awt257"},{"key":"S0033291726103705_r89","doi-asserted-by":"publisher","DOI":"10.1080\/17522439.2020.1757742"},{"key":"S0033291726103705_r95","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2022.0277"},{"key":"S0033291726103705_r98","doi-asserted-by":"publisher","DOI":"10.1016\/j.concog.2021.103086"},{"key":"S0033291726103705_r112","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0314965"},{"key":"S0033291726103705_r66","doi-asserted-by":"publisher","DOI":"10.1111\/papt.12260"},{"key":"S0033291726103705_r99","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2013.07.032"},{"key":"S0033291726103705_r124","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbl027"},{"key":"S0033291726103705_r75","doi-asserted-by":"publisher","DOI":"10.1080\/1047840X.2018.1480619"},{"key":"S0033291726103705_r127","doi-asserted-by":"publisher","DOI":"10.1027\/2151-2604\/a000337"},{"key":"S0033291726103705_r4","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2021.01.023"},{"key":"S0033291726103705_r107","doi-asserted-by":"publisher","DOI":"10.1192\/S0007125000296438"},{"key":"S0033291726103705_r54","doi-asserted-by":"publisher","DOI":"10.1177\/1368430218793190"},{"key":"S0033291726103705_r86","doi-asserted-by":"publisher","DOI":"10.1017\/S1352465801003010"},{"key":"S0033291726103705_r79","doi-asserted-by":"publisher","DOI":"10.1007\/s10608-014-9600-5"},{"key":"S0033291726103705_r40","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291725001242"},{"key":"S0033291726103705_r45","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-999093"},{"key":"S0033291726103705_r24","doi-asserted-by":"publisher","DOI":"10.1098\/rstb.2017.0025"},{"key":"S0033291726103705_r47","doi-asserted-by":"publisher","DOI":"10.1017\/S003329170700013X"},{"key":"S0033291726103705_r62","doi-asserted-by":"publisher","DOI":"10.2466\/pr0.94.2.501-513"},{"key":"S0033291726103705_r74","doi-asserted-by":"publisher","DOI":"10.1037\/abn0000495"},{"key":"S0033291726103705_r42","doi-asserted-by":"publisher","DOI":"10.1136\/bmjment-2023-300880"},{"key":"S0033291726103705_r51","doi-asserted-by":"publisher","DOI":"10.3758\/s13423-018-1488-8"},{"key":"S0033291726103705_r87","doi-asserted-by":"publisher","DOI":"10.1080\/13546800701566686"},{"key":"S0033291726103705_r97","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbtep.2016.08.006"},{"key":"S0033291726103705_r78","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2025.102687"},{"key":"S0033291726103705_r110","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2017.05.024"},{"key":"S0033291726103705_r8","first-page":"337","volume-title":"The neuropsychology of schizophrenia","author":"Bentall","year":"1994"},{"key":"S0033291726103705_r7","first-page":"1","article-title":"What can experimental studies tell us about paranoia and anxiety? A systematic review with implications for theory and clinical practice","volume":"53","author":"Bennetts","year":"2021","journal-title":"Psychosis"},{"key":"S0033291726103705_r83","doi-asserted-by":"crossref","first-page":"1038","DOI":"10.1176\/ajp.132.10.1038","article-title":"Persecutory delusions: A cybernetic model","volume":"132","author":"Melges","year":"1975","journal-title":"American Journal of Psychiatry"},{"key":"S0033291726103705_r123","volume-title":"Rediscovering the social group: A self-categorization theory","author":"Turner","year":"1987"},{"key":"S0033291726103705_r30","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-clinpsy-080921-081114"},{"key":"S0033291726103705_r43","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2019.07.016"},{"key":"S0033291726103705_r49","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2021.0326"},{"key":"S0033291726103705_r93","doi-asserted-by":"publisher","DOI":"10.1080\/13546805.2015.1067601"},{"key":"S0033291726103705_r53","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2004.03.006"},{"key":"S0033291726103705_r15","doi-asserted-by":"publisher","DOI":"10.1080\/13546800802332145"},{"key":"S0033291726103705_r23","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awm173"},{"key":"S0033291726103705_r100","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(18)30053-1"},{"key":"S0033291726103705_r36","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(21)00158-9"},{"key":"S0033291726103705_r106","doi-asserted-by":"publisher","DOI":"10.1007\/s11097-021-09764-9"},{"key":"S0033291726103705_r116","doi-asserted-by":"publisher","DOI":"10.1177\/17456916221082967"},{"key":"S0033291726103705_r120","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2018.05.015"},{"key":"S0033291726103705_r31","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbw194"},{"key":"S0033291726103705_r10","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.158.4.527"},{"key":"S0033291726103705_r1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2013.00047"},{"key":"S0033291726103705_r14","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2017.04.006"},{"key":"S0033291726103705_r16","first-page":"251","volume-title":"Handbook of psychotherapy case formulation, second edition","author":"Caspar","year":"2011"},{"key":"S0033291726103705_r58","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(23)00411-X"},{"key":"S0033291726103705_r60","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.149.1.51"},{"key":"S0033291726103705_r113","doi-asserted-by":"publisher","DOI":"10.1007\/s10608-019-10070-7"},{"key":"S0033291726103705_r65","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)62036-X"},{"key":"S0033291726103705_r68","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2016.09.002"},{"key":"S0033291726103705_r52","doi-asserted-by":"publisher","DOI":"10.1038\/s44220-025-00558-5"},{"key":"S0033291726103705_r109","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awae122"},{"key":"S0033291726103705_r34","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(16)00066-3"},{"key":"S0033291726103705_r129","doi-asserted-by":"publisher","DOI":"10.1016\/j.nlm.2006.09.005"},{"key":"S0033291726103705_r56","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2024.2040"},{"key":"S0033291726103705_r57","first-page":"21677026231218639","article-title":"Paranoia: From passive social-threat perception to Misattunement in social interaction","volume":"24","author":"Hajd\u00fak","year":"2024","journal-title":"Clinical Psychological Science"},{"key":"S0033291726103705_r104","doi-asserted-by":"publisher","DOI":"10.1038\/4580"},{"key":"S0033291726103705_r61","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2011.2310"},{"key":"S0033291726103705_r103","doi-asserted-by":"publisher","DOI":"10.1038\/s41562-018-0495-0"},{"key":"S0033291726103705_r71","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.160.1.13"},{"key":"S0033291726103705_r48","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291701003312"},{"key":"S0033291726103705_r77","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2017.02108"},{"key":"S0033291726103705_r27","doi-asserted-by":"publisher","DOI":"10.1038\/s44271-025-00311-9"},{"key":"S0033291726103705_r64","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbp006"},{"key":"S0033291726103705_r39","doi-asserted-by":"publisher","DOI":"10.1348\/014466502760387461"},{"key":"S0033291726103705_r55","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-clinpsy-032816-045145"},{"key":"S0033291726103705_r84","doi-asserted-by":"publisher","DOI":"10.1080\/13546805.2019.1664443"},{"key":"S0033291726103705_r6","volume-title":"Schizophrenia: Cognitive theory, research, and therapy","author":"Beck","year":"2009"}],"container-title":["Psychological Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0033291726103705","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T09:01:42Z","timestamp":1777971702000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0033291726103705\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":129,"alternative-id":["S0033291726103705"],"URL":"https:\/\/doi.org\/10.1017\/s0033291726103705","relation":{},"ISSN":["0033-2917","1469-8978"],"issn-type":[{"value":"0033-2917","type":"print"},{"value":"1469-8978","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]},"assertion":[{"value":"\u00a9 The Author(s), 2026. Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e127"}}