Psychological treatment for voices in psychosis (original) (raw)
Related papers
Schizophrenia research, 2018
Few patients have access to cognitive behaviour therapy for psychosis (CBTp) even though at least 16 sessions of CBTp is recommended in treatment guidelines. Briefer CBTp could improve access as the same number of therapists could see more patients. In addition, focusing on single psychotic symptoms, such as auditory hallucinations ('voices'), rather than on psychosis more broadly, may yield greater benefits. This pilot RCT recruited 28 participants (with a range of diagnoses) from NHS mental health services who were distressed by hearing voices. The study compared an 8-session guided self-help CBT intervention for distressing voices with a wait-list control. Data were collected at baseline and at 12weeks with post-therapy assessments conducted blind to allocation. Voice-impact was the pre-determined primary outcome. Secondary outcomes were depression, anxiety, wellbeing and recovery. Mechanism measures were self-esteem, beliefs about self, beliefs about voices and voice-rel...
Cognitive behavioural therapy group work with voice hearers. Part 2
2007
This study presents a small, randomized control trial of cognitive behavioural interventions within a group setting for the treatment of auditory hallucinations. In a sample of 20 voice hearers, 10 were randomly allocated to an eight-session cognitive behavioural therapy group, and 10 underwent psychiatric 'treatment as usual'. Baseline assessments were undertaken. Measures of control, power, frequency, and symptoms of distress and anxiety, were recorded on assessment and on completion of the group. The groups achieved a significant reduction in frequency of auditory hallucinations and in the beliefs about the power of the voice. Satisfaction measures also suggested that the group participants valued the group and benefited from the structured sessions. Universality, the recognition that other people experience very similar problems, was one of the most beneficial factors of the intervention. This study suggests that group cognitive behavioural therapy was helpful in the treatment of auditory hallucinations.
Cognitive behavioural therapy group work with voice hearers. Part 1
British Journal of Nursing, 2013
This study presents a small, randomized control trial of cognitive behavioural interventions within a group setting for the treatment of auditory hallucinations. In a sample of 20 voice hearers, 10 were randomly allocated to an eight-session cognitive behavioural therapy group, and 10 underwent psychiatric 'treatment as usual'. Baseline assessments were undertaken. Measures of control, power, frequency, and symptoms of distress and anxiety, were recorded on assessment and on completion of the group. The groups achieved a significant reduction in frequency of auditory hallucinations and in the beliefs about the power of the voice. Satisfaction measures also suggested that the group participants valued the group and benefited from the structured sessions. Universality, the recognition that other people experience very similar problems, was one of the most beneficial factors of the intervention. This study suggests that group cognitive behavioural therapy was helpful in the treatment of auditory hallucinations.
What are the effects of group cognitive behaviour therapy for voices? A randomised control trial
2005
Background: Little evidence exists for the effects of psychological treatment on voices even though it is clear that CBT does affect delusions and symptoms overall. This study tested whether a group based on cognitive behavioural principles could produce beneficial effects on hallucinations. Aim: To test the effectiveness of group CBT on social functioning and severity of hallucinations. Method: Participants were included if they had a diagnosis of schizophrenia and experienced distressing auditory hallucinations (rated on the PANSS). They were randomly allocated to group CBT (N = 45) or a control group who received treatment as usual (N = 40). The two main outcomes were social functioning as measured by the Social Behaviour Schedule and the severity of hallucinations as measured by the total score on the Hallucinations Scale of PSYRATS. Assessments were carried out at baseline, 10 weeks (post therapy) and 36 weeks (six months following therapy). Results: Mixed random effects models revealed significant improvement in social functioning (effect size 0.63 six months after the end of therapy). There was no general effect of group CBTon the severity of hallucinations. However, there was a large cluster effect of therapy group on the severity of hallucinations such that they were reduced in some but not all of the therapy groups. Improvement in hallucinations was associated with receiving therapy early in the trial and having very experienced therapists (extensive CBT training which included expert supervision for a series of individual cases for at least a year following initial training). Conclusion: Group CBT does improve social functioning but unless therapy is provided by experienced CBT therapists hallucinations are not reduced. D
Brief Coping Strategy Enhancement for Distressing Voices: an Evaluation in Routine Clinical Practice
Behavioural and cognitive psychotherapy, 2017
Hearing voices can be a common and distressing experience. Psychological treatment in the form of cognitive behavioural therapy for psychosis (CBTp) is effective, but is rarely available to patients. The barriers to increasing access include a lack of time for clinicians to deliver therapy. Emerging evidence suggests that CBTp delivered in brief forms can be effective and offer one solution to increasing access. We adapted an existing form of CBTp, coping strategy enhancement (CSE), to focus specifically on distressing voices in a brief format. This intervention was evaluated within an uncontrolled study conducted in routine clinical practice. This was a service evaluation comparing pre-post outcomes in patients who had completed CSE over four sessions within a specialist out-patient service within NHS Mental Health Services. The primary outcome was the distress scale of the Psychotic Symptoms Rating Scale - Auditory Hallucinations (PSYRATS-AH). Data were available from 101 patients...
The paper presents a clinical case study of a psychotherapeutic intervention, based on the model developed by Romme & Escher (2000), with an adult man in acute psychotic crisis who hears voices. The aim of this intervention was to decode the meaning of the voices and link the voices to the person's history. At the same time, the person was trained in the use of cognitive and behavioural coping strategies, in order to manage the hearing voices experience and gain control over it. The specific case study was chosen because it highlights, amongst others, issues pertaining to disturbed communication and dynamics between family members, which createdouble-bind conditions and obstructthe development of an adult identity. The impediments in developing an adult identity pose obstacles to the achievement of the person's autonomy and their detachment from their family of origin. In the paper we present the successive stages of the intervention, with emphasis on the changes achieved in each phase regarding making sense of and managing the client's voices, and discuss its overall effectiveness for acquiring control over the hearing voices experience.
Relating therapy for voices (the R2V study): study protocol for a pilot randomized controlled trial
Trials, 2014
Background: Evidence exists for the effectiveness of cognitive behaviour therapy for psychosis with moderate effect sizes, but the evidence for cognitive behaviour therapy specifically for distressing voices is less convincing. An alternative symptom-based approach may be warranted and a body of literature has explored distressing voices from an interpersonal perspective. This literature has informed the development of relating therapy and findings from a case series suggested that this intervention was acceptable to hearers and therapists. Methods/Design: An external pilot randomized controlled trial (RCT) comparing outcomes for 15 patients receiving 16 hours (weekly sessions of one hour) of relating therapy and their usual treatment with 15 patients receiving only their usual treatment. Participants will be assessed using questionnaires at baseline, 16 weeks (post-intervention), and 36 weeks (follow-up). Discussion: Expected outcomes will include a refined study protocol and an estimate of the effect size to inform the sample size of a definitive RCT. If evidence from a fully powered RCT suggests that relating therapy is effective, the therapy will extend the range of evidence-based psychological therapies available to people who hear distressing voices. Trial registration: Current Controlled Trials ISRCTN registration number 44114663. Registered on 13 June 2013.
Changing Relationship with Voices: New Therapeutic Perspectives for
A growing body of research on verbal hallucinations shows the importance of beliefs about and relationships with the voices for their pathological course. In particular, beliefs about the omnipotence of the voices and the need to control them, and relationships with them that involve efforts to resist or fi ght them, have shown themselves to be more pathogenic than effective. Likewise, treatments aimed at eliminating the voices, be they based on medication or 'traditional' cognitive-behavioural therapy, have not always been successful. A series of strategies focused on changing relationships with the voices instead of trying to eliminate them-including mindfulness, acceptance, experiential role plays and re-authoring lives-is emerging as a new perspective for the treatment of hallucinations. All of these strategies are based on the person, not on the syndrome, which also represents a new conception of the problem, in a phenomenological-social perspective, alternative to the predominant medical conception.