Momentary effects of Temstem, an app for voice-hearing individuals: Results from naturalistic data from 1048 users

Recognition and management of auditory verbal hallucinations in borderline personality disorder

Background

Auditory verbal hallucinations (AVH) are experienced by 25% of all people diagnosed with a borderline personality disorder. Since the impact of these hallucinations is often substantial, we asked ourselves how often they are discussed in clinical practice, whether they are treated, and if so, how and to what effect.

Methods

We studied the clinical files of 130 people under treatment at a specialized outpatient clinic for people with personality disorders, and compared the data on the presence and treatment of AVH to those collected in four prior scientific studies by our group.

Results

Of the 130 participants to those earlier studies, 42 had reported on experiencing AVH ≥ once per week. In 31% of the cases this had been missed by the treating healthcare professionals. Of the people suffering from severe AVH, a concurrent schizophrenia spectrum disorder was diagnosed in only 10%. A minority of 41% had received targeted treatment for their AVH. Doses of antipsychotics had been relatively low compared to those recommended for psychotic disorders, and yet all patients treated had reported a decrease in the frequency or severity (or both) of their AVH. Unfortunately, 93% also reported side effects, which led 57% of the group to discontinue this type of treatment. Nonpharmacological treatments such as cognitive behavioral therapy had been offered only to a minority of the participants.

Conclusion

Even in specialized clinical settings it remains challenging to establish the possible presence of AVH in people with a borderline personality disorder. And yet this is worth the effort because of the impact that these hallucinations tend to have, and the positive effects of antipsychotic treatment here presented. Further research is needed to develop algorithms to optimize doses in individual patients, to develop treatment guidelines, and to explore the effects of nonpharmacological treatments.

Digital Therapeutics in Hearing Healthcare: Evidence-Based Review

Digital therapeutics (DTx) in hearing research have emerged as a new category of therapies providing evidence-based intervention via digital means, such as software, smartphone apps, or websites. However, although relatively new, they are not well-established. In this article, we review DTx technologies in hearing research fields, focusing on three categories: prevention and diagnosis, aid (assistance), and cure (digital medicine). We observe that most DTx systems require interactions with users (or patients) without the direct support of clinical professionals to obtain or collect medical evidence; this makes training (or education) features crucial to the therapy's success. In this view, this article discusses the education or training functions of the current DTx and their contribution and purposes. The impact of emerging artificial intelligence (AI) on DTx in hearing research is being explored, and the future of DTx concerning AI integration is being discussed. We believe that this work will contribute to a better understanding of the current and future DTx technological advancements and, in particular, shed light on the field of hearing research.

Effects on voice hearing distress and social functioning of unguided application of a smartphone app - A randomized controlled trial

Background

Temstem is a smartphone app developed with and for clinical voice hearing individuals with the aim to reduce their voice hearing distress and improve social functioning.

Methods

A randomized controlled trial with adult outpatients suffering from distressing and frequent auditory verbal hallucinations (AVH) was conducted. Participants were randomized to unguided 'Temstem+AVH monitoring' or unguided 'AVH monitoring only' (control condition). Assessments were performed at baseline, post-intervention (week 5-6), and follow-up (week 9-10). Primary outcomes were voice hearing distress and social functioning, as measured with Experience Sampling Method (ESM), consisting of multiple daily questionnaires during six days. In addition, voices and mood were self-monitored with help of a daily reflective questionnaire. Analyses were linear regression models (intention-to-treat).

Results

44 Participants were allocated to Temstem and 45 to the control condition. No significant differences between the groups were found on both primary outcomes.

Conclusion

Our results do not support the effectiveness of stand-alone use of Temstem versus symptom monitoring on voice hearing distress or social functioning in voice hearing individuals. In order to potentially improve effectiveness of an mHealth tool in a population of people with frequent and distressing voices, we recommend to involve persons with lived experience in all stages of development and research; to thoroughly test the (technological) usability before performing an RCT; to test whether guidance of a therapist is needed to optimize effectiveness; and to provide prompts to remind the user to actually use the tool.