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Zanello A, Perez AG, Maksimovic J, Wood S, Sentissi O. Validation and clinical usefulness of the Hamilton Program for Schizophrenia Voices Questionnaire (HPSVQ) among French-speaking voice-hearers. L'ENCEPHALE 2024; 50:300-308. [PMID: 37718200 DOI: 10.1016/j.encep.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 09/19/2023]
Abstract
Auditory verbal hallucinations (AVH), also called voices, are often distressing to individuals experiencing them. Valid and reliable instruments are necessary to document the hearing voices experience across cultures. The Hamilton Program for Schizophrenia Voices Questionnaire (HPSVQ) is becoming a widely used self-administered instrument for assessing characteristics, content and subjective effect of AVH. This study investigates the psychometric characteristics of the HPSVQ French version (HPSVQ FV) in a clinical sample of voice-hearers. The results showed that the HPSVQ yields a global score (HPSVQ-Global) as well as a distress (HPSVQ-Distress) and a severity (HPSVQ-Severity) sub-score having good, acceptable and questionable internal consistency respectively. Significant correlations were found between hallucination severity (BPRS 4.0), distress (PSYRATS-AH), voices acceptance (VAAS-9), anxiety and depression (HADS). However, no significant associations were observed between Suspicion and Unusual Thoughts (BPRS 4.0). At a one-week interval, the temporal stability of the three indices was excellent. Moreover, after a brief cognitive intervention, a significant reduction was observed in all indices. Taken together, the HPSVQ FV demonstrated good construct validity, reliability and sensitivity to change. These findings support the use of the HPSVQ in francophone clinical and research settings. However, the bi-factorial solution of the HPSVQ FV should be further examined in larger samples.
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Affiliation(s)
| | | | | | - Sophie Wood
- HUG Department of Psychiatry, Geneva, Switzerland
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Salt E, Skeffington P, Reddyhough C, Paulik G. Assessment of Voice Content for Voice Hearers: Psychometric Evaluation of the Perth Voice Content Questionnaire. Clin Psychol Psychother 2024; 31:e2991. [PMID: 38706173 DOI: 10.1002/cpp.2991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/11/2024] [Accepted: 04/09/2024] [Indexed: 05/07/2024]
Abstract
The experience of hearing voices is common to an estimated 7% of the general population, with the presence of negative content being the best predictor of whether individuals will require clinical support. Whilst largely neglected in the literature to date, there are calls to consider the significance of voice content for reducing voice-related distress. However, no quantitative and comprehensive measure of voice content with suitability for research and clinical use exists. This pilot study aimed to demonstrate preliminary psychometric properties of a newly developed measure, the Perth Voice Content Questionnaire (PVCQ), designed to measure the intensity and themes of positively and negatively valenced voice content, primarily of the dominant voice. The PVCQ and measures of voice severity and related beliefs were completed by 47 voice-hearing participants. The measure was found to be internally consistent, loaded onto two distinct factors of positive and negative content, and these factors were associated with voice-related distress and negative beliefs about voices and positive beliefs about voices, respectively, indicating good validity. The PVCQ offers the first self-report measure of voice content, with preliminary psychometric properties indicating its suitability for clinical and research use.
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Affiliation(s)
- Erica Salt
- School of Psychology, Murdoch University, Murdoch, Western Australia, Australia
| | - Petra Skeffington
- School of Psychology, Murdoch University, Murdoch, Western Australia, Australia
| | - Caitlin Reddyhough
- School of Psychology, Murdoch University, Murdoch, Western Australia, Australia
- Translational Research Division, Perth Voices Clinic, Murdoch, Western Australia, Australia
| | - Georgie Paulik
- School of Psychology, Murdoch University, Murdoch, Western Australia, Australia
- Translational Research Division, Perth Voices Clinic, Murdoch, Western Australia, Australia
- School of Psychology, Curtin University, Perth, Western Australia, Australia
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3
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Hayward M, Bibby-Jones AM, Thomas N, Paulik G, Mutanda D, Berry C. Multi-modal hallucinations across diagnoses: What relationships do they have with voice-related distress? Schizophr Res 2024; 265:58-65. [PMID: 37230912 DOI: 10.1016/j.schres.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 04/15/2023] [Accepted: 04/15/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Research into hallucinatory experiences has focused primarily upon hallucinations within the auditory modality, to the relative neglect of other modalities. Furthermore, the exploration of auditory hallucinations (or 'voices') has focused primarily upon the experiences of people with a diagnosis of psychosis. The presence of multi-modal hallucinations may have implications across diagnoses for levels of distress, formulation and the targeting of psychological interventions. METHODS This study presents a cross-sectional analysis of observational data from the PREFER survey (N = 335). Linear regression was used to explore the relationships between voice-related distress and the presence, number, type and timing of multi-modal hallucinations. RESULTS Simple relationships were not found between distress and the presence of hallucinations in visual, tactile, olfactory or gustatory modalities, or in the number of modalities experienced. When considering the degree to which another modality hallucination was experienced simultaneously with voices, there was some evidence that the degree of co-occurrence with visual hallucinations was predictive of distress. CONCLUSIONS The co-occurrence of voices with visual hallucinations may be associated with relatively greater distress, but not consistently, and the association between multimodal hallucinations and clinical impact appear complex and potentially variable from individual to individual. Further study of associated variables such as perceived voice power may further illuminate these relationships.
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Affiliation(s)
- Mark Hayward
- School of Psychology, University of Sussex, Brighton BN1 9RH, UK.
| | | | - Neil Thomas
- Swinburne University of Technology, Australia.
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Piesse E, Paulik G, Mathersul D, Valentine L, Kamitsis I, Bendall S. An exploration of the relationship between voices, dissociation, and post-traumatic stress disorder symptoms. Psychol Psychother 2023; 96:1015-1028. [PMID: 37800445 DOI: 10.1111/papt.12493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 08/09/2023] [Accepted: 08/23/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVES Extensive research has shown voice hearing to be associated with symptoms of Post-Traumatic Stress Disorder (PTSD) and dissociation. However, most studies have adopted a quantitative design, using cross-sectional data sampling methods, precluding temporal relationships between variables from being defined. DESIGN Using a qualitative design, this study sought to identify potential symptom relationships by addressing the research question: what is the nature of the temporal relationship between voices, dissociation and PTSD symptoms? METHODS Seven voice hearers (aged 27 to 68 years) participated in a semi-structured interview exploring voice hearing, PTSD symptoms, and dissociation. The interviews were analysed using Interpretative Phenomenological Analysis. RESULTS One superordinate theme was identified in the data. Voices were observed to occur in dynamic interrelationship with PTSD symptoms and dissociation, and were frequently experienced before and after PTSD symptoms and dissociative episodes. CONCLUSIONS Implications for theoretical understandings of voice hearing and future research are discussed.
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Affiliation(s)
- Emily Piesse
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia
| | - Georgie Paulik
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia
- Perth Voices Clinic, Murdoch University, Murdoch, Western Australia, Australia
- School of Psychological Science, University of Western Australia, Nedlands, Western Australia, Australia
| | - Danielle Mathersul
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia
- Centre for Molecular Medicine and Innovative Therapeutics, Health Futures Institute, Murdoch University, Murdoch, Western Australia, Australia
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Lee Valentine
- Orygen and Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Ilias Kamitsis
- Orygen and Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Sarah Bendall
- Orygen and Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
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Pugh M, Bibby-Jones AM, Coyle-Stewart A, Hayward M. Relating Therapy for Distressing Voices in the Context of Anorexia Nervosa: A Case Series. J Nerv Ment Dis 2023; 211:784-790. [PMID: 37782520 DOI: 10.1097/nmd.0000000000001690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
ABSTRACT Voice hearing experiences are commonly reported by patients with anorexia nervosa (AN) and are associated with negative outcomes. The "eating disorder voice" (EDV) can be understood within relational frameworks. Relating therapy (RT) has offered encouraging outcomes when targeted at voice hearing experiences transdiagnostically but has not been evaluated in the context of AN. This study aimed to offer a preliminary and mixed methods exploration of RT for the EDV. RT was delivered to three participants with a diagnosis of AN who were distressed by an EDV. Weight, negative impact of voices, and eating disorder cognitions were assessed at baseline, posttherapy and at brief follow-up. Participant experiences were explored through exit interviews. Therapy was completed by all participants. Weight gain was reported by two participants and maintained at brief follow-up. Positive changes were not reported on other measures. Qualitative data were suggestive of positive experiences that facilitated assertive responding.
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Affiliation(s)
- Matthew Pugh
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Anna-Marie Bibby-Jones
- Research and Development Department, Sussex Partnership NHS Foundation Trust, Millview, Hove, UK
| | | | - Mark Hayward
- Research and Development Department, Sussex Partnership NHS Foundation Trust, Millview, Hove, UK
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Zanello A, Mutanda D, Sentissi O, Hayward M. Coping Strategy Enhancement for Auditory Verbal Hallucinations Within Routine Clinical Practice. J Nerv Ment Dis 2023; 211:79-82. [PMID: 36596290 DOI: 10.1097/nmd.0000000000001589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
ABSTRACT Auditory verbal hallucinations (AVH) are often multiple distressing experiences. Emerging evidence suggests that interventions informed by the principles of cognitive behavioral therapy, such as brief Cognitive Strategy Enhancement (brief-CSE), can reduce the distress related to AVH. The benefits of brief-CSE have been demonstrated for English-speaking patients. This uncontrolled pilot study, conducted in routine clinical practice, evaluated the benefits of brief-CSE within a group of French-speaking AVH hearers. Thirty-two patients were offered the brief-CSE intervention. Self-administered questionnaires were completed pre-post intervention. A significant reduction was observed in AVH distress, with a large effect size, and for more than half of the patients, this reduction was clinically meaningful. AVH severity and anxiety also decreased significantly. This study demonstrates that brief-CSE can be implemented in non-English-speaking routine clinical practice and can reduce several aspects of AVH subjective experience. There is a need to confirm these findings in a larger sample.
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Affiliation(s)
- Adriano Zanello
- HUG Department of Mental Health and Psychiatry, University Hospitals of Geneva, Thônex, Switzerland
| | - Daniel Mutanda
- R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Hove
| | - Othman Sentissi
- HUG Department of Mental Health and Psychiatry, University Hospitals of Geneva, Thônex, Switzerland
| | - Mark Hayward
- School of Psychology, University of Sussex, Brighton, United Kingdom
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Hayward M, Frost H, Naito A, Jones AM. Coping strategy enhancement for the treatment of distressing voices in young people: A service evaluation within routine clinical practice. Clin Child Psychol Psychiatry 2022; 27:1209-1220. [PMID: 35261271 PMCID: PMC9574902 DOI: 10.1177/13591045211061803] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hearing voices is a common experience in young people, irrespective of diagnosis. This experience can be associated with distress, self-harm and an increased risk of attempting suicide. However, there are currently no evidence-based interventions which specifically target distressing voice hearing experiences in young people. METHOD This was a service evaluation exploring the engagement, outcomes and experiences of young people who were offered a brief 4-session intervention for distressing voices within a Child and Adolescent Mental Health Service (CAMHS) in the UK's National Health Service. The intervention was based on the principles of Coping Strategy Enhancement (CSE). RESULTS A total of 24 young people were offered the CSE intervention over a 20-month period. The intervention was completed by 15 young people. Pre-post outcomes suggested clinically meaningful reductions in the negative impact of voices for the majority of the young people. Qualitative feedback was positive and highlighted the value of both a space to talk about voice hearing experiences and a focus upon coping strategies. CONCLUSIONS The findings from this service evaluation suggest that CSE can be a brief, acceptable and helpful way for young people within a CAMHS context to start a therapeutic conversation about their distressing voice hearing experiences.
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Affiliation(s)
- Mark Hayward
- R&D Department, Sussex Education Centre, 8944Sussex Partnership NHS Foundation Trust, Hove, UK.,School of Psychology, 1948University of Sussex, Brighton, UK
| | - Hazel Frost
- R&D Department, Sussex Education Centre, 8944Sussex Partnership NHS Foundation Trust, Hove, UK
| | - Akira Naito
- R&D Department, Sussex Education Centre, 8944Sussex Partnership NHS Foundation Trust, Hove, UK
| | - Anna-Marie Jones
- R&D Department, Sussex Education Centre, 8944Sussex Partnership NHS Foundation Trust, Hove, UK
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Brand RM, Badcock JC, Paulik G. Changes in positive and negative voice content in cognitive-behavioural therapy for distressing voices. Psychol Psychother 2022; 95:807-819. [PMID: 35523677 PMCID: PMC9542164 DOI: 10.1111/papt.12399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/19/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE People who experience distressing voices frequently report negative (e.g. abusive or threatening) voice content and this is a key driver of distress. There has also been recognition that positive (e.g. reassuring, or guiding) voice content contributes to better outcomes. Despite this, voice content has been neglected as a standalone outcome in evaluations of psychological therapies for distressing voices. We aimed to examine whether a modular cognitive-behavioural therapy (CBT) intervention for voices led to changes in negative and positive voice content. DESIGN/METHODS In a naturalistic, uncontrolled pre- and post- service evaluation study, 32 clients at an outpatient psychology service for distressing voices received eight sessions of CBT for distressing voices and completed self-report measures of negative and positive voice content at pre-, mid- and post- therapy. RESULTS There was no significant change in positive voice content. There was no significant change in negative voice content from pre- to post-therapy; however, there was a significant change in negative voice content between mid and post-treatment in which the cognitive therapy component was delivered. The CBT treatment was also associated with significant changes in routinely reported outcomes of voice-related distress and voice severity. CONCLUSIONS The cognitive component of CBT for distressing voices may be associated with changes in negative, but not positive, voice content. There may be benefit to enhancing these effects by developing treatments targeting specific processes involved in negative and positive voice content and further exploring efficacy in well-powered, controlled trials with more comprehensive measures of voice content.
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Affiliation(s)
- Rachel M. Brand
- School of Health and Behavioural SciencesUniversity of the Sunshine CoastSippy DownsQueenslandAustralia
| | - Johanna C. Badcock
- Perth Voices ClinicMurdochWestern AustraliaAustralia,School of Psychological ScienceUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Georgie Paulik
- Perth Voices ClinicMurdochWestern AustraliaAustralia,School of Psychological ScienceUniversity of Western AustraliaPerthWestern AustraliaAustralia,Discipline of PsychologyMurdoch UniversityMurdochWestern AustraliaAustralia
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Burr C, Schnackenberg JK, Weidner F. Talk-based approaches to support people who are distressed by their experience of hearing voices: A scoping review. Front Psychiatry 2022; 13:983999. [PMID: 36299547 PMCID: PMC9589913 DOI: 10.3389/fpsyt.2022.983999] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/14/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The positive effects of both antipsychotic medication and cognitive behavioral therapy in psychosis (CBTp) for people who are distressed by their experience of hearing voices remain limited. As a result, there has been a recent surge in talk-based individual approaches. Many of these continue not to be very well known nor implemented in practice. Some of the approaches may focus more on understanding and dealing constructively with voices, an element that has been identified as potentially helpful by voice hearers. Existing barriers to a wider implementation include both the widespread pathologization of hearing voices and a lack of mental health professionals who have been trained and trusted to carry out these new interventions. METHODS This scoping review aimed to identify and describe a current synthesis of talk-based individual approaches for people who hear voices, including studies independently of method of study or approach, diagnosis of voice hearers nor of the professional background of interventionists. RESULTS Nine different talk-based approaches were identified. These included: (1) Cognitive Behavioral Therapy for Psychosis (CBTp); (2) AVATAR therapy; (3) Making Sense of Voices (MsV) aka Experience Focused Counselling (EFC); (4) Relating Therapy; (5) Acceptance and Commitment Therapy; (6) Smartphone-based Coping-focused Intervention; (7) Prolonged and Virtual Reality Exposure Therapy; (8) Eye Movement Desensitization and Reprocessing, and (9) Individual Mindfulness-based Program for Voice Hearing. The different approaches differed greatly in relation to the number of sessions, length of time offered and the scientific evidence on efficacy. Psychologists represented the main professional group of interventionists. CBTp and the MsV/EFC approach also included health professionals, like nurses, as implementers. Most of the approaches showed positive outcomes in relation to voice related distress levels. None identified overall or voice specific deteriorations. CONCLUSION There appears to be a strong case for the implementation of a broader heterogeneity of approaches in practice. This would also be in line with recommendations for recovery focused services and requirements of voice hearers. A greater emphasis on whole systems implementation and thus the involvement of frontline staff, like nurses, in the delivery of these approaches would likely reduce the research-practice implementation gap.
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Affiliation(s)
- Christian Burr
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.,University Hospital of Psychiatry and Psychotherapy, University Hospital for Mental Health, Bern, Switzerland.,Faculty of Nursing Science, Vinzenz Pallotti University, Vallendar, Germany
| | | | - Frank Weidner
- Faculty of Nursing Science, Vinzenz Pallotti University, Vallendar, Germany
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Morrice F, Jones AM, Burgio V, Strauss C, Hayward M. Brief coping strategy enhancement for the treatment of distressing voices in the context of borderline personality disorder: A comparison with outcomes in the context of psychosis. Clin Psychol Psychother 2021; 29:567-578. [PMID: 34255401 DOI: 10.1002/cpp.2647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/21/2021] [Accepted: 06/28/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Voice hearing in the context of Borderline Personality Disorder (BPD) has traditionally been regarded as transient and an experience that lacks legitimacy. Consequently, there are no evidence-based treatments for the voices reported by BPD patients. Contrary to the traditional view, there is a growing literature suggesting that voice hearing in the context of BPD can be an enduring and distressing experience which shares similarities with voice hearing in the context of psychosis. Given these similarities, the aim of this study was to explore whether brief Coping Strategy Enhancement developed in the context of psychosis can be used to treat distressing voice hearing in the context of BPD. METHOD This was a service evaluation carried out in a specialist NHS service delivering psychological therapies for distressing voices. Patients with either a BPD (n = 46) or a psychosis diagnosis (n = 125) received four sessions of Coping Strategy Enhancement (CSE). The primary outcome was voice-related distress. The pre-post outcomes for BPD patients were explored and compared with those achieved by the psychosis patients. RESULTS Both the BPD and psychosis groups experienced a significant reduction in voice-related distress after CSE compared with baseline. The interaction between diagnosis group and time was small and statistically non-significant. CONCLUSION These findings suggest a brief CSE intervention developed in the context of psychosis can be an effective starting point in the treatment of distressing voice hearing in the context of BPD. Such interventions have the potential to be integrated into broader BPD treatment programmes for those who hear voices.
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Affiliation(s)
| | - Anna-Marie Jones
- Research and Development Department, Sussex Partnership NHS Foundation Trust, Hove, UK
| | - Vincenzo Burgio
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Clara Strauss
- School of Psychology, University of Sussex, Brighton, UK.,Research and Development Department, Sussex Partnership NHS Foundation Trust, Hove, UK
| | - Mark Hayward
- School of Psychology, University of Sussex, Brighton, UK.,Research and Development Department, Sussex Partnership NHS Foundation Trust, Hove, UK
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Increasing access to brief Coping Strategy Enhancement for distressing voices: a service valuation exploring a possible role for briefly-trained therapists. COGNITIVE BEHAVIOUR THERAPIST 2021. [DOI: 10.1017/s1754470x21000143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Abstract
Hearing voices is a distressing and trans-diagnostic experience. Cognitive behavioural therapy (CBT) is an effective psychological treatment for distressing voices, but is offered to only a minority of patients. Limited resources are a barrier to accessing CBT. Evaluations of brief forms of CBT for voices have offered encouraging findings, but the ability of briefly-trained therapists to deliver these brief therapies has yet to be explored. We evaluated the outcomes of a brief form of CBT (Coping Strategy Enhancement, CSE) for voices when delivered by highly-trained and briefly-trained therapists. This was a service evaluation comparing pre–post outcomes in patients who had completed brief CSE over four sessions, within NHS Mental Health Services, delivered by highly-trained and briefly-trained therapists. The primary outcome was the negative impact scale of the Hamilton Program for Schizophrenia Voices Questionnaire. Data were available from 92 patients who completed a course of brief CSE – nearly half of whom received therapy from a briefly-trained therapist. Modest benefits across the sample were consistent with previous evaluations and did not seem to be influenced by the training of the therapist. This service evaluation offers further evidence that brief CSE can begin a therapeutic conversation about distressing voices within routine clinical practice. The usefulness of this initial conversation does not seem to be reliant upon the extent of therapist training, suggesting that briefly-trained therapists may play a role in increasing access to these conversations for patients distressed by hearing voices.
Key learning aims
(1)
How can access to CBT be increased for patients distressed by hearing voices?
(2)
Can a wider workforce of briefly-trained therapists start a CBT-informed conversation about distressing voices?
(3)
How do the outcomes of these conversations compare with the same conversations facilitated by highly trained therapists?
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