Understanding the Barriers to Accessing Symptom-Specific Cognitive Behavior Therapy (CBT) for Distressing Voices: Reflecting on and Extending the Lessons Learnt From the CBT for Psychosis Literature (original) (raw)
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Trials
Background The National Institute for Health and Care Excellence (NICE) recommends that Cognitive Behaviour Therapy for psychosis (CBTp) is offered to all patients with a psychosis diagnosis. However, only a minority of psychosis patients in England and Wales are offered CBTp. This is attributable, in part, to the resource-intensive nature of CBTp. One response to this problem has been the development of CBTp in brief formats that are targeted at a single symptom and the mechanisms that maintain distress. We have developed a brief form of CBTp for distressing voices and reported preliminary evidence for its effectiveness when delivered by highly trained therapists (clinical psychologists). This study will investigate the delivery of this intervention by a cost-effective workforce of assistant psychologists following a brief training and evaluate the acceptability and feasibility of conducting a future, definitive, randomised controlled trial (RCT). Methods This is a feasibility stud...
BJPsych Open, 2021
Background Cognitive–behavioural therapy (CBT) is recommended for all patients with psychosis, but is offered to only a minority. This is attributable, in part, to the resource-intensive nature of CBT for psychosis. Responses have included the development of CBT for psychosis in brief and targeted formats, and its delivery by briefly trained therapists. This study explored a combination of these responses by investigating a brief, CBT-informed intervention targeted at distressing voices (the GiVE intervention) administered by a briefly trained workforce of assistant psychologists. Aims To explore the feasibility of conducting a randomised controlled trial to evaluate the clinical and cost-effectiveness of the GiVE intervention when delivered by assistant psychologists to patients with psychosis. Method This was a three-arm, feasibility, randomised controlled trial comparing the GiVE intervention, a supportive counselling intervention and treatment as usual, recruiting across two sit...
Acta Psychiatrica Scandinavica, 2010
To evaluate cognitive behaviour therapy for psychosis (CBTp) delivered by non-expert therapists, using CBT relevant measures. Participants (N = 74) were randomised into immediate therapy or waiting list control groups. The therapy group was offered 6 months of therapy and followed up 3 months later. The waiting list group received therapy after waiting 9 months (becoming the delayed therapy group). Depression improved in the combined therapy group at both the end of therapy and follow-up. Other significant effects were found in only one of the two therapy groups (positive symptoms; cognitive flexibility; uncontrollability of thoughts) or one of the two time points (end of therapy: general symptoms, anxiety, suicidal ideation, social functioning, resistance to voices; follow-up: power beliefs about voices, negative symptoms). There was no difference in costs between the groups. The only robust improvement was in depression. Nevertheless, there were further encouraging but modest improvements in both emotional and cognitive variables, in addition to psychotic symptoms.
Psychological treatment for voices in psychosis
Cognitive Neuropsychiatry, 2004
Hearing voices is often one of the most distressing aspects associated with a diagnosis of psychosis. These voices are often resistant to medication treatments. This review article discusses the development of complementary approaches to the treatment of voicesÐpsychological and particularly cognitive treatments. It is clear that there are psychological rather than merely physical factors associated with the occurrence of, and distress caused by, voices. These factors can be engaged in the process of psychological therapy in order to reduce the distress that they cause and improve quality of life. Psychological therapies have produced some improvements but very few have shown durable effects. Most psychological therapies have been individual with an emphasis on cognitive behavioural approaches. This paper describes the development of a new approachÐgroup cognitive treatmentÐthat might provide further success either as a single therapy for voices or as a complement to individual approaches. This type of therapy builds on the therapies and supports provided within the consumer movement as well as harnessing group and cognitive facilitators for change in beliefs. Some evidence is provided about the usefulness of such therapy in the health services. In addition, the evaluation of treatments for specific symptoms, particularly the appropriate outcome measures is discussed. Apart from cognitive deficits, hearing voices is one of the earliest signs of likely psychosis and one of the main causes of distress to people with a diagnosis of schizophrenia. There is evidence that these voices can persist even after adequate levels of medication have been prescribed in 25±50% patients (Pantellis & Barnes, 1996) and these treatment-resistant voices are a major concern to both patients and their relatives. This paper is concerned with the developments of complementary psychological approaches to the treatment of voices, which have mainly been investigated in groups of people with treatmentresistant voices. Psychological treatment options are popular with both patients and their relatives and although this review is not a systematic meta-analysis it will draw together the evidence on the efficacy of the various treatments in order that a more measured approach to provision can be taken. Assessing the effects
Cognitive behavioural therapy for psychosis targeting trauma, voices and dissociation: a case report
The Cognitive Behaviour Therapist
Trauma and dissociation may be important factors contributing to the experiences of distressing voice hearing. However, there is scant mention of how to target and treat such processes when working with people with psychosis. This case study reports on an initial attempt to work with dissociation and trauma memories in a person with voices. A single case approach was used, with standardized measures used before, during and after 24 sessions of cognitive therapy, and at 6-month follow-up. In addition, session-by-session measures tracked frequency and distress associated with voices and dissociation. The participant reported significant improvements in terms of reduced frequency and distress of dissociation, and voice hearing, as well as improvement in low mood at the end of treatment. At follow-up there were enduring benefits in terms of dissociation and trauma-related experiences, as well as broad recovery but not of change in voices. This case illustrated the potential benefit of t...
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...