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Said O, Sengun Filiz E, Stringer D, Applewhite B, Kellermann V, Mutwalli H, Bektas S, Akkese MN, Kumar A, Carter B, Simic M, Sually D, Bentley J, Young AH, Madden S, Byford S, Landau S, Lawrence V, Treasure J, Schmidt U, Nicholls D, Himmerich H. Olanzapine for young PEople with aNorexia nervosa (OPEN): A protocol for an open-label feasibility study. EUROPEAN EATING DISORDERS REVIEW 2024; 32:532-546. [PMID: 38299859 DOI: 10.1002/erv.3060] [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: 05/12/2023] [Revised: 12/13/2023] [Accepted: 12/30/2023] [Indexed: 02/02/2024]
Abstract
INTRODUCTION Antipsychotics are routinely prescribed off-label for anorexia nervosa (AN) despite limited evidence. This article presents a protocol of a study aiming to assess the feasibility of a future definitive trial on olanzapine in young people with AN. METHODS AND ANALYSIS In an open-label, one-armed feasibility study, 55 patients with AN or atypical AN, aged 12-24, receiving outpatient, inpatient or day-care treatment who are considered for olanzapine treatment will be recruited from NHS sites based in England. Assessments will be conducted at screening, baseline and at 8-, 16 weeks, 6- and 12 months. Primary feasibility parameters will be proportions of patients who agree to take olanzapine and who adhere to treatment and complete study assessments. Qualitative methods will be used to explore acceptability of the intervention and study design. Secondary feasibility parameters will be changes in body mass index, psychopathology, side effects, health-related quality of life, carer burden and proportion of participants who would enrol in a future randomised controlled trial. The study is funded by the National Institute for Health Research via Health Technology Assessment programme. DISCUSSION Olanzapine for young PEople with aNorexia nervosa will inform a future randomised controlled trial on the efficacy and safety of prescribing olanzapine in young people with AN.
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Affiliation(s)
- Olena Said
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ece Sengun Filiz
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - Dominic Stringer
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Briana Applewhite
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Vanessa Kellermann
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Hiba Mutwalli
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Clinical Nutrition, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Sevgi Bektas
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Melahat Nur Akkese
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ashish Kumar
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Mersey Care NHS Foundation Trust, Merseyside, UK
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Mima Simic
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Dilveer Sually
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jessica Bentley
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Sloane Madden
- University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Byford
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sabine Landau
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Vanessa Lawrence
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ulrike Schmidt
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Dasha Nicholls
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - Hubertus Himmerich
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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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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Kubera KM, Rashidi M, Schmitgen MM, Barth A, Hirjak D, Otte ML, Sambataro F, Calhoun VD, Wolf RC. Functional network interactions in patients with schizophrenia with persistent auditory verbal hallucinations: A multimodal MRI fusion approach using three-way pICA. Schizophr Res 2024; 265:20-29. [PMID: 37024417 DOI: 10.1016/j.schres.2023.03.001] [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: 10/23/2022] [Revised: 02/18/2023] [Accepted: 03/03/2023] [Indexed: 04/08/2023]
Abstract
Over the last decade, there have been an increasing number of functional magnetic resonance imaging (fMRI) studies examining brain activity in schizophrenia (SZ) patients with persistent auditory verbal hallucinations (AVH) using either task-based or resting-state fMRI (rs-fMRI) paradigms. Such data have been conventionally collected and analyzed as distinct modalities, disregarding putative crossmodal interactions. Recently, it has become possible to incorporate two or more modalities in one comprehensive analysis to uncover hidden patterns of neural dysfunction not sufficiently captured by separate analysis. A novel multivariate fusion approach to multimodal data analysis, i.e., parallel independent component analysis (pICA), has been previously shown to be a powerful tool in this regard. We utilized three-way pICA to study covarying components among fractional amplitude of low-frequency fluctuations (fALFF) for rs-MRI and task-based activation computed from an alertness and a working memory (WM) paradigm of 15 SZ patients with AVH, 16 non-hallucinating SZ patients (nAVH), and 19 healthy controls (HC). The strongest connected triplet (false discovery rate (FDR)-corrected pairwise correlations) comprised a frontostriatal/temporal network (fALFF), a temporal/sensorimotor network (alertness task), and a frontoparietal network (WM task). Frontoparietal and frontostriatal/temporal network strength significantly differed between AVH patients and HC. Phenomenological features such as omnipotence and malevolence of AVH were associated with temporal/sensorimotor and frontoparietal network strength. The transmodal data confirm a complex interplay of neural systems subserving attentional processes and cognitive control interacting with speech and language processing networks. In addition, the data emphasize the importance of sensorimotor regions modulating specific symptom dimensions of AVH.
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Affiliation(s)
- Katharina M Kubera
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Germany
| | - Mahmoud Rashidi
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Germany
| | - Mike M Schmitgen
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Germany
| | - Anja Barth
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Germany
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Marie-Luise Otte
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Germany
| | - Fabio Sambataro
- Department of Neuroscience (DNS), University of Padua, Padua, Italy; Padua Neuroscience Center, University of Padua, Padua, Italy
| | - Vince D Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
| | - Robert C Wolf
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Germany.
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Marffy MJ, Fox J, Williams M. An exploration of the relationship between loneliness, the severity of eating disorder-related symptoms and the experience of the 'anorexic voice'. Psychol Psychother 2024; 97:122-137. [PMID: 37792343 DOI: 10.1111/papt.12502] [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: 11/06/2022] [Accepted: 09/22/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVES Many individuals with eating disorders (EDs) report the experience of an 'Anorexic voice' (AV). Negative experiences of loneliness are also often associated with EDs. This study sought to explore the relationship between experiences of loneliness, the frequency of the AV and the impact of this on ED symptom severity. DESIGN 165 individuals (mean age 27.54 years) who accessed online forums relating to EDs participated in this study. The sample included individuals who have experienced an AV [AV group (N = 141)] and those who have not [non-AV group (N = 23)]. METHODS The study utilised self-report measures via an online questionnaire to explore the predictive validity of loneliness and frequency of the AV on ED symptom severity. RESULTS Confirmatory analysis (AV group only) demonstrated the significance of the independent variables individually predicting ED symptom severity. However, a significant interaction was not found between the two primary variables in predicting ED symptom severity, more significantly than the influence of either variable alone. Exploratory analysis considered the differences between the two groups (AV and Non-AV), as well as considering alternate predictors. CONCLUSIONS The findings offer insight into possible drivers behind engagement with the AV, as part of ED presentations in the community.
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Affiliation(s)
| | - John Fox
- DClinPsy, Cardiff University, Cardiff, UK
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Kalofonos I, Zito M, Fletcher E, Calderon R, Nazinyan M, Kern R. A pilot trial examining the effects of veteran voices and visions, an adaptation of hearing voices groups for a large public health system in the United States. Int J Soc Psychiatry 2024; 70:122-131. [PMID: 37724417 DOI: 10.1177/00207640231196747] [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] [Indexed: 09/20/2023]
Abstract
BACKGROUND The Hearing Voices Approach, a community-based peer-led support group model, is generating interest as a novel way to engage with psychosis. Hearing Voices (HV) groups are run by peers, 'experts-by-experience', and emphasize group ownership and community-building rather than adherence to a therapist-led, predetermined structure. Diverse beliefs about experiences are respected and viewed as potentially meaningful. Groups work within each individual's explanatory framework to reframe understandings. AIMS This paper describes the effects of participation in Veteran Voices and Visions (VVV) groups, an adaptation of the HV approach, co-led by clinicians and Veteran peer support specialists, adapted for Veterans who have experienced psychosis and receive care at the VA, a large public health system in the United States. METHOD This mixed methods pilot study has a convergent parallel design, integrating quantitative and qualitative data from participants in pre-intervention and post-intervention assessments. RESULTS Over 16 weeks, quantitative analysis showed a statistically significant reduction in distress, due to auditory hallucinations, as measured by the Psychotic Symptom Rating Scales (PSYRATS). The Beliefs about Voices Questionnaire- Revised (BAVQ-R) results showed a reduction in malevolence and omnipotence and an increase in benevolence related to auditory hallucinations, but no change in resistance. Engagement showed a trend-level reduction. Qualitative data from midpoint (Week 8) and endpoint (Week 16) interviews revealed several perceived benefits from groups: 1) normalization and camaraderie, 2) increased hope and confidence, 3) self-understanding and reframing of experiences, and 4) building relationships outside of groups. Overall, VVV groups reduced distress due to voices, negative beliefs about voices, and perceived power of voices. CONCLUSIONS Study findings contribute to a growing body of literature indicating HV groups support those who have experienced psychosis by reducing social isolation and fostering community, which may facilitate social integration. Overall, our findings highlight the potential benefits of adapting HV groups to health systems.
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Affiliation(s)
| | - Michael Zito
- VA Greater Los Angeles Healthcare System, CA, USA
| | | | | | | | - Robert Kern
- VA Greater Los Angeles Healthcare System, CA, USA
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Yang HM, Lung H, Yang MC, Lung FW. DRD4 VNTR 4/4 homozygosity as a genetic biomarker for treatment selection in patients with schizophrenia. Asian J Psychiatr 2024; 91:103831. [PMID: 37988928 DOI: 10.1016/j.ajp.2023.103831] [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: 05/22/2023] [Revised: 10/03/2023] [Accepted: 11/04/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE There seems to be an association between the DRD4 48-bp VNTR polymorphisms and antipsychotic treatment response, but there is a rare reference to confirm this finding. Hence, the present study tried to investigate the association between DRD4 48-bp VNTR polymorphisms and the treatment response of antipsychotics in patients with schizophrenia in Taiwan, using a propensity score matching (PSM) method. METHODS A total of 882 participants were enrolled in this study and completed informed consent, research questionnaires, including demographic information and the revised Chinese version Beliefs about Voices Questionnaire, and blood sampling. For descreasing of the selection bias and confounding variables, the PSM nearest neighbor matching method was used to select 765 paitents with schizophrenia (ratio of 1:8 between 85 persistent auditory hallucination and 680 controls) with matched and controlled the age and gender. RESULTS Schizophrenia patients with DRD4 4 R homozygosity had a lower rate of good antipsychotic treatment response than the other DRD4 genotype carriers (DRD4 non-4/4). Among those 4 R homozygosity carriers, 60 cases of 503 (11.9%) retain persistent auditory hallucinations. Furthermore, this subgroup of patients is accounted for up to 70.6% of cases with poor neuroleptic treatment response. CONCLUSIONS A poor treatment outcome for patients with the 4 R homozygosity had presented,that comparing with those DRD non-4/4 genotype carriers. DRD4 VNTR 4 R homozygosity could be a genetic biomarker to predict poor antipsychotic treatment response in schizophrenia. Patients with DRD 4/4 probably receive novel antipsychotic medications preferentially or in combination with alternative therapy, such as psychotherapy or milieu therapy.
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Affiliation(s)
- Hao-Ming Yang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, Taiwan; Graduate Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan
| | - Hsuan Lung
- Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; School of Dentistry and Institute of Oral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | - For-Wey Lung
- Calo Psychiatric Center, Pingtung County, Taiwan; Graduate Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan; International Graduate Program of Education and Human Development, National SunYat-sen University, Kaohsiung, Taiwan; Institute of Education, National Sun Yat-Sen University, Kaohsiung, Taiwan.
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7
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Smith L, Rossell SL, Thomas N, Toh WL. Intersections of phenomenology, voice beliefs and distress in bipolar disorder: a comparison with schizophrenia. Behav Cogn Psychother 2024; 52:78-92. [PMID: 37749628 DOI: 10.1017/s1352465823000395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
BACKGROUND Auditory verbal hallucinations (AVH), or voice-hearing, can be a prominent symptom during fluctuating mood states in bipolar disorder (BD). AIMS The current study aimed to: (i) compare AVH-related distress in BD relative to schizophrenia (SCZ), (ii) examine correlations between phenomenology and voice beliefs across each group, and (iii) explore how voice beliefs may uniquely contribute to distress in BD and SCZ. METHOD Participants were recruited from two international sites in Australia (BD=31; SCZ=50) and the UK (BD=17). Basic demographic-clinical information was collected, and mood symptoms were assessed. To document AVH characteristics, a 4-factor model of the Psychotic Symptoms Rating Scale and the Beliefs about Voices Questionnaire-Revised were used. Statistical analyses consisted of group-wise comparisons, Pearson's correlations and multiple hierarchical regressions. RESULTS It was found that AVH-related distress was not significantly higher in BD than SCZ, but those with BD made significantly more internal attributions for their voices. In the BD group, AVH-related distress was significantly positively correlated with malevolence, omnipotence and resistance, However, only resistance, alongside mania and depressive symptoms, significantly contributed to AVH-related distress in BD. DISCUSSION Our findings have several clinical implications, including identification of voice resistance as a potential therapeutic target to prioritise in BD. Factoring in the influence of mood symptoms on AVH-related distress as well as adopting more acceptance-oriented therapies may also be of benefit.
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Affiliation(s)
- Lindsay Smith
- National and Specialist CAMHS, At-Risk and Forensic Service, South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, Maudsley Hospital, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Susan L Rossell
- Centre for Mental Health & Brain Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
- Department of Psychiatry, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Neil Thomas
- Centre for Mental Health & Brain Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
- Department of Psychology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Wei Lin Toh
- Centre for Mental Health & Brain Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
- Department of Psychiatry, St Vincent's Hospital, Melbourne, Victoria, Australia
- Department of Psychology, Alfred Hospital, Melbourne, Victoria, Australia
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Thompson A, Calissano C, Treasure J, Ball H, Montague A, Ward T, Cardi V. A case series to test the acceptability, feasibility and preliminary efficacy of AVATAR therapy in anorexia nervosa. J Eat Disord 2023; 11:181. [PMID: 37833732 PMCID: PMC10571357 DOI: 10.1186/s40337-023-00900-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Patients with anorexia nervosa tend to experience an inner "eating disorder" voice. They struggle to recognise and assert their own identity over the illness's identity and relate to it from a powerless and subordinate position. AVATAR therapy was developed to help patients with psychosis to gain greater power and control over distressing voices. The goal of this study was to test the feasibility, acceptability, safety and preliminary efficacy of an adaptation of AVATAR therapy for anorexia nervosa. METHODS Twelve adult patients with anorexia nervosa were recruited. Ten completed an assessment session and between five to seven therapy sessions. The assessment session consisted in the creation of an avatar to represent the "eating disorder". This was accomplished by manipulating auditory and visual characteristics through a specialist computer software. During the therapy sessions, patients interacted with the avatar to assert their own desires and will. Patients completed baseline, end of intervention and follow-up (4-week) online questionnaires. A non-concurrent multiple baselines single case experimental design (SCED) was used (A1BA2). Feasibility, acceptability, safety and preliminary efficacy of the intervention were assessed. RESULTS The therapy met pre-specified criteria relating to (1) Feasibility: sample recruited within three months; retention rate at the end of the treatment phase = 81.9%; therapy completion rate = 90.1%. (2) Safety: no serious adverse events associated with the intervention. (3) Acceptability: mean ratings = 7.5 (SD = 2.61) out of ten, on a 0-10 scale of acceptability (10 = complete satisfaction). With regards to efficacy, participants reported significantly lower levels of distress associated with the eating disorder voice and higher levels of self-compassion at the end of treatment. No other significant changes were observed in frequency of the eating disorder voice, voice's characteristics, such as omnipotence and malevolence, eating disorder symptoms and symptoms of anxiety, depression and stress. Patients' feedback indicated that the therapy had helped with their ability to stand up to the illness, make positive changes around eating, and increase their motivation to recover and self-compassion. CONCLUSION AVATAR therapy for anorexia nervosa is feasible, acceptable and safe for patients. Larger studies are needed to test clinical efficacy. TRIAL REGISTRATION The study was pre-registered on the clinicaltrials.gov registry (https://clinicaltrials.gov/ct2/show/NCT04778423).
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Affiliation(s)
| | | | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Hannah Ball
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9NT, UK
- Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
| | - Alice Montague
- North East London Foundation NHS Trust, London, E17 3HP, UK
- Department of Psychology, Department of Clinical, Educational, and Health Psychology, University College London, London, WC1E 7HB, UK
| | - Thomas Ward
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Valentina Cardi
- Department of General Psychology, University of Padova, Padova, Italy.
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK.
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O’Brien-Venus B, Jenkins T, Chadwick P. Self-dehumanisation in voice hearers: the end of a continuum. Front Psychiatry 2023; 14:1173380. [PMID: 37854440 PMCID: PMC10579558 DOI: 10.3389/fpsyt.2023.1173380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 09/18/2023] [Indexed: 10/20/2023] Open
Abstract
Background Meta-dehumanisation and self-dehumanisation have been identified as potentially relevant phenomena for developing a deeper understanding of distress related to voice-hearing, particularly those experiencing voices as part of psychosis. Chadwick has previously argued that those with psychosis, including those who hear distressing voices, typically feel "dehumanised and set apart by their experiences of psychosis and trauma." The present study explores the subjective experience of self-dehumanisation in people who experience distressing voices, which was selected as a useful starting point to inform future research focused on understanding dehumanisation in people with psychosis. Methods Qualitative data was obtained through twenty semi-structured interviews with self-identifying voice hearers and analysed using reflexive thematic analysis. This followed the recursive six phase procedure of Braun and Clarke, and this was conducted from a critical realist, contextualist position. Results Reflexive thematic analysis of participant's experiences produced a core theme, Dehumanisation as the End of Experiential Continua, and six subthemes: Extent of Distressing Sensory Fragmentation; Sense of Belonging with Other Humans; Integrity of Self as a Private, Coherent Entity; Sense of Worth as a Human Being; Strength of Personal Agency; and Trust in Own Credibility and Reliability. Two further themes, The Push and Pull of Dehumanising Forces and Reclaiming Life through Humanising Forces, were identified. Findings were presented to a panel of five experts by experience, all with lived experience of psychosis and service-use; all five strongly endorsed the themes as fitting with and expressing their own experiences of self-dehumanisation. Conclusion Reflexive thematic analysis of voice hearers' accounts identified self-dehumanisation as the endpoint where six experiential continua coalesce. Experiential movement along these continua was affected by a range of interpersonal, intrapersonal, and societal forces over time, including dehumanising attitudes of others and voice malevolence and omnipotence. Future research might examine if and how psychological therapies aimed at those experiencing distressing voices, such as people experiencing psychosis may address feelings of self-dehumanisation.
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Affiliation(s)
| | | | - Paul Chadwick
- Department of Psychology, University of Bath, Bath, United Kingdom
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10
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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 2023:S0013-7006(23)00142-2. [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] [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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11
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Longden E, Corstens D, Bowe S, Pyle M, Emsley R, Peters S, Branitsky A, Chauhan N, Dehmahdi N, Jones W, Holden N, Larkin A, Miners A, Murphy E, Steele A, Morrison AP. A psychological intervention for engaging dialogically with auditory hallucinations (Talking With Voices): A single-site, randomised controlled feasibility trial. Schizophr Res 2022; 250:172-179. [PMID: 36423442 PMCID: PMC9754007 DOI: 10.1016/j.schres.2022.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/03/2022] [Accepted: 11/06/2022] [Indexed: 11/22/2022]
Abstract
There is growing clinical interest in addressing relationship dynamics between service-users and their voices. The Talking With Voices (TwV) trial aimed to establish feasibility and acceptability of a novel dialogical intervention to reduce distress associated with voices amongst adults diagnosed with schizophrenia spectrum disorders. The single-site, single-blind (rater) randomised controlled trial recruited 50 participants who were allocated 1:1 to treatment as usual (TAU), or TAU plus up to 26 sessions of TwV therapy. Participants were assessed at baseline and again at end of treatment (six-months). The primary outcomes were quantitative and qualitative assessments of feasibility and acceptability. Secondary outcomes involved clinical measures, including targeted instruments for voice-hearing, dissociation, and emotional distress. The trial achieved 100 % of the target sample, 24 of whom were allocated to therapy and 26 to TAU. The trial had high retention (40/50 [80 %] participants at six-months) and high intervention adherence (21/24 [87.5 %] receiving ≥8 sessions). Signals of efficacy were shown in targeted measures of voice-hearing, dissociation, and perceptions of recovery. Analysis on the Positive and Negative Syndrome Scale indicated that there were no differences in means of general psychosis symptom scores in TwV compared to the control group. There were four serious adverse events in the therapy group and eight in TAU, none of which were related to study proceedings. The trial demonstrates the acceptability of the intervention and the feasibility of delivering it under controlled, randomised conditions. An adequately powered definitive trial is necessary to provide robust evidence regarding efficacy evaluation and cost-effectiveness. Trial registration: ISRCTN 45308981.
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Affiliation(s)
- Eleanor Longden
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
| | - Dirk Corstens
- GGZ Noord-Holland Noord, Texel/den Helder, the Netherlands
| | - Samantha Bowe
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Melissa Pyle
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Sarah Peters
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Alison Branitsky
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK,Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK,Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Nisha Chauhan
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Nikki Dehmahdi
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Wendy Jones
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK,Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Natasha Holden
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Amanda Larkin
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Alissa Miners
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Elizabeth Murphy
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Ann Steele
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Anthony P. Morrison
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK,Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
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12
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Rammou A, Berry C, Fowler D, Hayward M. Distress factors of voice-hearing in young people and social relating: Exploring a cognitive-interpersonal voice-hearing model. Psychol Psychother 2022; 95:939-957. [PMID: 35773751 PMCID: PMC9795969 DOI: 10.1111/papt.12411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/22/2022] [Accepted: 06/13/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Little is known about the factors that can maintain the distress related to voice-hearing experiences in youth. Building upon understandings developed with adults, this study aimed to explore the associations between negative relating between hearer and voices, persecutory beliefs about voices and voice-related distress in a clinical sample of adolescents. The study also aimed to investigate associations between relating to voices and wider patterns of social relating. DESIGN This was an observational, cross-sectional, survey study. METHODS Thirty-four young people (age 14-18 years) who were hearing voices completed measures about voices (characteristics, relating and beliefs) and relating to social others (negative relating styles, social connectedness and belongingness). Participants were patients of NHS mental health services. Bivariate correlations explored associations between relating to voices and distress, beliefs about voices and distress, and between relating to voices and social relating variables. RESULTS Perceiving the voices as dominant, intrusive, and persecutory and resisting them was significantly associated with distress. Adjusting for loudness and negative content rendered the association between persecutory beliefs and distress non-significant. Fear of separation and of being alone in relation to social others was associated with distancing from voices. Being suspicious, uncommunicative and self-reliant and/or being sadistic and intimidating towards social others was significantly associated with dependence towards the voices. Greater hearer-to-voice dependence was associated with lower perceived social belongingness and connectedness. CONCLUSIONS Beliefs about voices being persecutory, dominant, intrusive and resisting voices seem to be significant contributors of distress in young people. In terms of proximity and power, relating to voices and social others appears to be contrasting.
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Affiliation(s)
- Aikaterini Rammou
- School of PsychologyUniversity of SussexBrightonUK,Research & Development DepartmentSussex Partnership NHS Foundation TrustBrightonUK
| | - Clio Berry
- School of PsychologyUniversity of SussexBrightonUK,Brighton and Sussex Medical SchoolUniversity of SussexBrightonUK
| | - David Fowler
- School of PsychologyUniversity of SussexBrightonUK,Research & Development DepartmentSussex Partnership NHS Foundation TrustBrightonUK
| | - Mark Hayward
- School of PsychologyUniversity of SussexBrightonUK,Research & Development DepartmentSussex Partnership NHS Foundation TrustBrightonUK
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13
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Cavelti M, Kaeser JM, Lerch S, Bauer S, Moessner M, Berger T, Hayward M, Kaess M. Smartphone-assisted guided self-help cognitive behavioral therapy for young people with distressing voices (SmartVoices): study protocol for a randomized controlled trial. Trials 2022; 23:902. [PMID: 36274185 PMCID: PMC9590132 DOI: 10.1186/s13063-022-06846-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/14/2022] [Indexed: 11/25/2022] Open
Abstract
Background The long-standing view that auditory verbal hallucinations (AVH) or hearing voices is a sign of schizophrenia has been challenged by research demonstrating that they lie on a continuum ranging from normal to pathological experience related to distress and need for care. Hearing voices is more prevalent in adolescence than in later life, and hearing voices during adolescence indicates a risk for severe psychopathology, functional impairments, and suicide later in life. While there is increasing evidence for the efficacy of cognitive behavioral therapy for voices (CBTv) in adults with schizophrenia, research on psychological treatments for youth with distressing voices has been scarce. The aim of the current study is to examine the efficacy of CBTv, delivered using smartphone-based Ecological Momentary Assessment Intervention (EMI) in a transdiagnostic sample of youth. Methods This is a superiority randomized controlled trial comparing 8 weeks of CBTv-based EMI in addition to treatment as usual (TAU) versus TAU only. TAU covers both no treatment and any form of psychiatric/psychological treatment. In the EMI condition, participants will be prompted twice a day to complete an EMA survey, and receive one intervention proposal per assessment. One-hundred fifty-four youth aged 14–25 years with distressing voices will be recruited from psychiatric clinics, local private practices, internet forums, and advertisements in print and social media. Before and after the intervention phase, participants will undergo a 9-day EMA. Single-blinded assessments will be conducted at baseline (T0) and at 3-month (T1) and 6-month (T2) follow-up. The primary outcome is the distress dimension of the Auditory Hallucinations subscale of the Psychotic Symptom Rating Scales at T1. Secondary outcomes include perceived hostile intention, power, and dominance of voices, passive, aggressive, and assertive relating to voices, and negative core beliefs about the self. Discussion Adolescence provides a crucial window of opportunity for early intervention for hearing voices. However, youth are notoriously reluctant help-seekers. This study offers a low-intensity psychological intervention for youth with distressing voices beyond diagnostic boundaries that, using a mobile technology approach, may match the treatment preferences of the generation of “digital natives.” Trial registration German Clinical Trials Register DRKS00026243. Registered on 2 September 2021 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06846-0.
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14
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Lorente-Rovira E, Grasa E, Ochoa S, Corripio I, Peláez T, López-Carrilero R, Gutiérrez-Gea Á, Morano-Guillén M, Villagrán JM, Bartels-Velthuis AA, Jenner JA, Sanjuán J. Different measures for auditory hallucinations in populations with psychosis. The Validation of the Spanish versions of the Auditory Vocal Hallucination Rating Scale (AVHRS) and the Positive and Useful Voices Inquiry (PUVI). REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2022; 15:259-271. [PMID: 36513402 DOI: 10.1016/j.rpsmen.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 03/11/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION An updated summary of the most used instruments assessing auditory hallucinations in population with psychosis, allows us to underline the scarceness and need of Spanish versions of important instruments. The aim of the study is to examine the psychometric characteristics of two different and complementary instruments for assessing auditory hallucinations, the Spanish version of the Auditory Vocal Hallucination Scale (AVHRS) and the Spanish version of the Positive and Useful Voices Inquiry (PUVI). MATERIALS AND METHODS A sample of 68 patients from four different centres, with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder presenting with auditory hallucinations were included. Apart from the AVHRS and the PUVI, the Psychotic Symptom Rating Scales-Auditory Hallucinations subscale (PSYRATS-AH) and the Positive and Negative Syndrome Scale (PANSS) were also administered to all patients, plus an acceptability questionnaire. RESULTS The Spanish version of the AVHRS showed a good internal consistency, a moderate to high inter-rater reliability, a medium to moderate test-retest reliability, and a good convergent and discriminant validity. The Spanish version of the PUVI showed a good internal consistency and a heterogeneous, but in general moderate, test-retest reliability. CONCLUSIONS The Spanish versions of the AVHRS and the PUVI have good psychometric properties and are well accepted among patients.
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Affiliation(s)
- Esther Lorente-Rovira
- Hospital Clínico, Valencia, Spain; INCLIVA, Valencia, Spain; CIBERSAM, Madrid, Spain.
| | - Eva Grasa
- CIBERSAM, Madrid, Spain; Department of Psychiatry, Biomedical Research Institute Sant Pau (IIB-SANT PAU, Hospital Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Spain
| | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Barcelona, Spain; CIBERSAM, Madrid, Spain
| | - Iluminada Corripio
- CIBERSAM, Madrid, Spain; Department of Psychiatry, Biomedical Research Institute Sant Pau (IIB-SANT PAU, Hospital Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Spain
| | - Trinidad Peláez
- CIBERSAM, Madrid, Spain; Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | | | | | | | - José M Villagrán
- Hospital Jerez de la Frontera, Servicio Andaluz de Salud, Cádiz, Spain
| | - Agna A Bartels-Velthuis
- University of Groningen, the Netherlands; University Medical Center Groningen, University Center for Psychiatry, Groningen, the Netherlands
| | - Jack A Jenner
- Jenner Consult, Haren, the Netherlands Groningen, the Netherlands
| | - Julio Sanjuán
- Hospital Clínico, Valencia, Spain; INCLIVA, Valencia, Spain; CIBERSAM, Madrid, Spain; Faculty of Medicine, Valencia, Spain
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15
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Sheaves B, Johns L, Loe BS, Bold E, Černis E, Molodynski A, Freeman D. Listening to and Believing Derogatory and Threatening Voices. Schizophr Bull 2022; 49:151-160. [PMID: 35947487 PMCID: PMC9810006 DOI: 10.1093/schbul/sbac101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND HYPOTHESIS A plausible cause of distress for voice hearers is listening to and believing the threats and criticisms heard. Qualitative research indicates that patients have understandable reasons to listen. This study aimed to develop the understanding of distress using this listening and believing framework. Measures were developed of listening and believing voices and the reasons, and associations with distress tested. STUDY DESIGN A cross-sectional study of patients hearing derogatory and threatening voices (N = 591). Listening and Believing-Assessment and Listening and Believing-Reasons item pools were completed, and assessments of distress. Exploratory and confirmatory factor analyses and structural equation modeling (SEM) were conducted. STUDY RESULTS 52% (n = 307) of participants believed their voices most or all the time. Listening and believing had 4 factors: active listening, passive listening, believing, and disregarding. Higher levels of believing, active listening, and particularly passive listening were associated with higher levels of anxiety, depression, and voice distress. Reasons for listening and believing formed 7 factors: to better understand the threat; being too worn down to resist; to learn something insightful; being alone with time to listen; voices trying to capture attention; voices sounding like real people; and voices sounding like known people. Each type of reason was associated with active listening, passive listening, and believing. SEM showed that feeling worn down in particular accounted for listening and believing. Test-retest reliability of measures was excellent. CONCLUSIONS A framework of listening and believing negative voices has the potential to inform the understanding and treatment of voice distress.
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Affiliation(s)
- Bryony Sheaves
- To whom correspondence should be addressed; tel: 01865 618187, e-mail:
| | - Louise Johns
- Department of Psychiatry, University of Oxford, Oxford, UK,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Bao S Loe
- The Psychometrics Centre, University of Cambridge, Cambridge, UK
| | - Emily Bold
- Department of Psychiatry, University of Oxford, Oxford, UK,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Emma Černis
- Department of Psychiatry, University of Oxford, Oxford, UK,Oxford Health NHS Foundation Trust, Oxford, UK
| | | | - Andrew Molodynski
- Department of Psychiatry, University of Oxford, Oxford, UK,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, UK,Oxford Health NHS Foundation Trust, Oxford, UK
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16
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Loizou S, Fowler D, Hayward M. Measuring the longitudinal course of voice hearing under psychological interventions: A systematic review. Clin Psychol Rev 2022; 97:102191. [PMID: 35995024 DOI: 10.1016/j.cpr.2022.102191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 06/10/2022] [Accepted: 08/04/2022] [Indexed: 11/30/2022]
Abstract
Trials of psychological interventions targeting distressing voices have used a range of variables to measure outcomes. This has complicated attempts to compare outcomes across trials and to evaluate the effectiveness of these interventions. Therefore, this review aimed to identify the variables that have been used to measure the longitudinal course and impact of voice hearing under these interventions and to evaluate how these variables change over time. Inclusion and exclusion criteria were applied, resulting in a total of 66 articles. Of these, 60 studies (28 RCTs, 23 uncontrolled, 9 non-randomised) were published in peer-reviewed journals, whilst 6 were recently completed or currently ongoing. The findings of this review suggest that a range of variables that are not directly relevant to psychological interventions have been used (e.g., depression, characteristics of voice hearing experience), whilst those directly impacted by psychological interventions (e.g., voice-related distress), broader concepts of outcome (e.g., functioning) and specific associated processes (e.g., self-schema) have received less attention. Findings also showed that the majority of variables demonstrated improvements, but effect sizes varied considerably across trials. This may be attributed to methodological differences such as statistical power, blinding, control groups and different methods of measurement. Our review highlights the importance of determining a set of outcomes that are directly targeted and should change under psychological interventions. Recommendations include the use of voice-related distress as a primary outcome. This can ultimately facilitate comparisons across studies and inform the development of psychological interventions.
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Affiliation(s)
- Sofia Loizou
- School of Psychology, University of Sussex, Falmer BN1 9QH, UK.
| | - David Fowler
- School of Psychology, University of Sussex, Falmer BN1 9QH, UK
| | - Mark Hayward
- School of Psychology, University of Sussex, Falmer BN1 9QH, UK; Research & Development Department, Sussex Partnership NHS Foundation Trust, Nevill Avenue, Hove BN7 3HZ, UK
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17
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Rajanthiran L, Curtis G, Ayalde J, Orr K, Melvill-Smith P, Banerjee A, Schenk M, Wearne D. 'Is hearing believing?': A study of voices and beliefs in psychosis and trauma. Australas Psychiatry 2022; 30:547-551. [PMID: 35968743 DOI: 10.1177/10398562221106064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study compared voice characteristics and beliefs in participants diagnosed with post-traumatic stress disorder (PTSD) with dissociation, schizophrenia (SCZ) and both diagnoses of SCZ and PTSD. The relationship between dissociation and voice beliefs was also assessed. METHOD We identified 56 participants meeting the diagnostic criteria for PTSD with dissociation, SCZ or both diagnoses (PTSD + SCZ) who also experienced auditory hallucinations. Measures included PTSD Symptoms Scales Interview (PSSI-5), Psychotic Symptoms Rating Scale (PSYRAT), Clinician Administered Dissociative States Scale (CADSS), Beliefs about Voices Questionnaire (BAVQ) and Positive and Negative Syndrome Scale (PANSS). RESULTS Beliefs about voices were similar across diagnostic groups. Participants with SCZ were more likely to attribute their voices to an external origin, and participants with dual diagnosis were less able to control their voices. The PTSD-only group scored higher in dissociation scores than either the SCZ-only or dual diagnosis group. Malevolent voice appraisals correlated with dissociation scores only in the dual diagnosis group. CONCLUSIONS This research supports the hypothesis that voice beliefs are similar across diagnoses of PTSD and SCZ. However, differences in voice characteristics, emotional responses and relationship to dissociation may need to be considered in the psychological management of voices.
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Affiliation(s)
| | - Guy Curtis
- School of Psychology, UWA, Perth, Western Australia
| | | | - Kenneth Orr
- 103905Marian Center, Perth, Western Australia
| | | | - Amit Banerjee
- Headspace Youth Early Psychosis Program, Perth, Western Australia
| | - Meta Schenk
- 103905Marian Center, Perth, Western Australia
| | - Deborah Wearne
- School of Medicine, University of Western Australia (UWA), Perth, Western Australia
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18
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Visual P300 as a neurophysiological correlate of symptomatic improvement by a virtual reality-based computer AT system in patients with auditory verbal hallucinations: A Pilot study. J Psychiatr Res 2022; 151:261-271. [PMID: 35512620 DOI: 10.1016/j.jpsychires.2022.04.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/09/2022] [Accepted: 04/20/2022] [Indexed: 11/24/2022]
Abstract
Previous comparative trials showed that virtual reality (VR) therapies achieved larger effects than gold-standard cognitive-behavioral therapy (CBT) on overall auditory verbal hallucinations (AVHs). However, no trial has examined the corresponding underlying electrophysiological mechanisms. We performed a pilot randomized comparative trial evaluating the efficacy of a virtual reality-based computer AT system (CATS) over CBT for schizophrenia (SCZ) patients with treatment-resistant AVHs and explored these potential electrophysiological changes via the visual P300 component. Patients (CATS, n = 32; CBT, n = 33) completed the clinical assessments pre- and post-interventions and at 12-week follow-up. The visual P300 were measured before and after both therapies. The analysis of changes in psychiatric symptoms used linear mixed-effects models, and the P300 response in temporal and time-frequency domains was analyzed with repeated-measures analysis of variance. There was no interaction effect between change in clinical symptoms and treatment group. However, several statistically significant within-group improvements were found for CATS and CBT over time. AVH improved significantly after both treatments, as measured with the Psychotic Symptom Rating Scales-Auditory Hallucinations (PSYRATS-AH) sub-scores. Especially for the CATS group, omnipotence beliefs, anxiety symptoms, self-esteem, and quality of life also remained improved at the 12-week follow-up. Moreover, P300 amplitude had a significant interaction effect and correlation with AVH response. Overall, our analysis did not demonstrate general clinical superiority of CATS over CBT, but CATS improved refractory AVH in SCZ patients, likely by increasing P300 amplitude. These findings support the continued development of CATS for persistent AVH and suggest further trials to clarify the neurological effects of CATS.
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19
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Choudhary A, Ranjan JK, Asthana HS, Chaudhury S. The appraisal-distress relationship of auditory hallucinations in patients with schizophrenia: The moderating role of metacognitive beliefs. Ind Psychiatry J 2022; 31:248-254. [PMID: 36419698 PMCID: PMC9678164 DOI: 10.4103/ipj.ipj_248_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/17/2021] [Accepted: 12/27/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Appraisal of hallucinatory voices plays a significant role in anxiety and depression among patients with auditory hallucinations. Metacognitive beliefs are also associated with psychological distress in schizophrenia patients. However, there is a dearth of literature exploring the role of metacognitive beliefs on the appraisal-distress relationship, specifically, the overemphasis laid on the need to maintain consistency among thoughts and avoid cognitive dissonance. AIM The aim of the study is to study the role of metacognitive beliefs on the appraisal-distress relationship. MATERIALS AND METHODS A total of 126 schizophrenia patients with auditory hallucinations were selected through purposive sampling technique. The participants were assessed on Hindi version of beliefs about voices questionnaire-revised (BAVQ-R), hospital anxiety and depression scale, metacognition questionnaire-short, and modified (MCQ-SAM). RESULTS Correlation analysis indicated significant relationship between the dimensions of BAVQ-R (i.e., benevolence, malevolence, and omnipotence) and MCQ-SAM (i.e., cognitive self-consciousness, positive beliefs about worry, importance of consistency of thoughts, and beliefs about normal experience of unwanted thoughts), depression and anxiety. Hierarchical regression analysis indicated that benevolence, malevolence, and importance of consistency of thoughts were predictors of anxiety; malevolence, importance of consistency of thoughts and positive beliefs about worry were predictors of depression. Results of moderation analysis indicated that malevolent beliefs about voices predict the intensity of distress among clinical voice-hearers, and importance of consistency of thoughts plays a moderating role in this appraisal-distress relationship. CONCLUSION In schizophrenia patients with auditory hallucinations, the appraisal-distress relationship is strengthened when the need to maintain cognitive consistency is over-emphasized.
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Affiliation(s)
| | | | | | - Suprakash Chaudhury
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
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20
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Ellett L, Dannahy L, Chadwick P. Engagement, clinical outcomes and therapeutic process in online mindfulness for psychosis groups delivered in routine care. Psychol Psychother 2022; 95:467-476. [PMID: 35049131 PMCID: PMC9303574 DOI: 10.1111/papt.12382] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/24/2021] [Accepted: 01/04/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES There is growing evidence for the benefit of mindfulness-based interventions (MBI) for people with psychosis. However, research is yet to evaluate the clinical benefit of delivering MBI groups online. We examine engagement, clinical outcomes, participant experience and therapeutic process of delivering therapy groups online in routine clinical practice. METHODS The study used an uncontrolled pre-post design to examine engagement, therapeutic benefits (depression, anxiety, beliefs about voices) and group process in a 12-session online mindfulness group for individuals with a schizophrenia spectrum diagnosis with current distressing voices. Qualitative data on participant experience of online group therapy were analysed using Thematic Analysis. RESULTS 17/21 participants (81%) completed one of three consecutively run therapy groups. For completers there were significant reductions pre-post in depression, anxiety, beliefs about voices and voice-related negative affect, with medium to large effect sizes. There were individuals showing reliable and clinically significant improvements in each clinical outcome, and none showing reliable or clinically significant deterioriation. Participants' rankings of the importance of different group therapeutic factors were very similar to those observed in face-to-face mindfulness for psychosis groups. Qualitative analysis of participant feedback identified three themes: 'experience of online delivery', 'therapeutic benefits' and 'feeling connected to people in the group'. CONCLUSIONS Findings in relation to therapy engagement, clinical benefits, participant experience and group process offer encouragement that online delivery of mindfulness for psychosis groups may be a useful addition to mental health services for people with distressing voices.
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21
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Mourgues C, Hammer A, Fisher V, Kafadar E, Quagan B, Bien C, Jaeger H, Thomas R, Sibarium E, Negreira AM, Sarisik E, Polisetty V, Nur Eken H, Imtiaz A, Niles H, Sheldon AD, Powers AR. Measuring Voluntary Control Over Hallucinations: The Yale Control Over Perceptual Experiences (COPE) Scales. Schizophr Bull 2022; 48:673-683. [PMID: 35089361 PMCID: PMC9077437 DOI: 10.1093/schbul/sbab144] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Auditory verbal hallucinations (AVH) frequently cause significant distress and dysfunction, and may be unresponsive to conventional treatments. Some voice-hearers report an ability to fully control the onset and offset of their AVH, making them significantly less disruptive. Measuring and understanding these abilities may lead to novel interventions to enhance control over AVH. Fifty-two voice-hearers participated in the pilot study. 318 participants with frequent AVH participated in the validation study. A pool of 59 items was developed by a diverse team including voice-hearers and clinicians. After the pilot study, 35 items were retained. Factorial structure was assessed with exploratory (EFA, n = 148) and confirmatory (CFA, n = 170) factor analyses. Reliability and convergent validity were assessed using a comprehensive battery of validated phenomenological and clinical scales. CFA on the final 18 items supported two factors for a Methods of Control Scale (5 items each, average ω = .87), and one factor for a Degree of Control Scale (8 items, average ω = .95). Correlation with clinical measures supported convergent validity. Degree of control was associated with positive clinical outcomes in voice-hearers both with and without a psychosis-spectrum diagnosis. Degree of control also varied with quality of life independently of symptom severity and AVH content. The Yale control over perceptual experiences (COPE) Scales robustly measure voice-hearers' control over AVH and exhibit sound psychometric properties. Results demonstrate that the capacity to voluntarily control AVH is independently associated with positive clinical outcomes. Reliable measurement of control over AVH will enable future development of interventions meant to bolster that control.
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Affiliation(s)
| | | | | | - Eren Kafadar
- Yale University School of Medicine, New Haven, CT,USA
| | | | - Claire Bien
- Yale University School of Medicine, New Haven, CT,USA
| | - Hale Jaeger
- Yale University School of Medicine, New Haven, CT,USA
| | - Rigi Thomas
- Southwest College of Naturopathic Medicine, Tempe, AZ, USA
| | - Ely Sibarium
- Yale University School of Medicine, New Haven, CT,USA
| | | | - Elif Sarisik
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Vasishta Polisetty
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Hatice Nur Eken
- School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Ayyub Imtiaz
- Faculty of Medicine, Health Sciences Center, Kuwait University, Kuwait City, Kuwait
| | - Halsey Niles
- Yale University School of Medicine, New Haven, CT,USA
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22
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Partridge O, Maguire T, Newman-Taylor K. How does attachment style affect psychosis? A systematic review of causal mechanisms and guide to future inquiry. Psychol Psychother 2022; 95:345-380. [PMID: 34687273 DOI: 10.1111/papt.12371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 07/19/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE The link between attachment and psychosis is now well established, but less is known about the causal mechanisms underlying this relationship. This systematic review synthesises the studies that examine mediating mechanisms in the attachment and psychosis relationship, in both clinical and non-clinical samples. METHOD We conducted a database search (PsychINFO, MEDLINE, Web of Science) to identify all eligible studies irrespective of publication status, the language of article or article date. We assessed methodological quality and completed a narrative synthesis given the heterogeneity of studies to date. RESULTS We identified 17 papers, comprising 3,672 participants. The relationship between attachment and psychosis is mediated by four variables or groups of variables. There is good evidence for the causal role of affective factors (affective dysregulation and affective disturbances) and cognitive factors (e.g., self-beliefs and self-esteem and beliefs about symptoms). Affective factors differed by attachment style. Tentative evidence was found for the role of duration of untreated psychosis and baseline negative symptoms. CONCLUSIONS Cognitive and affective factors mediate the relationship between attachment style and psychosis. Whilst cognitive factors are routinely targeted in recommended psychological interventions for psychosis, affective factors and attachment style are less commonly considered. Psychological therapies may be improved by calibrating cognitive and affective interventions by attachment style, which should be subjected to experimental and then field studies to assess the impact on clinical and recovery outcomes. PRACTITIONER POINTS The relationship between attachment and psychosis is now well established, and studies have started to examine mediating mechanisms. Affective and cognitive factors mediate the attachment-psychosis relationship. Affective factors differ by attachment style. There is limited evidence for the duration of untreated psychosis and negative psychotic symptoms as mediating mechanisms, and research replication is needed. Cognitive factors are routinely targeted in recommended psychological therapies for psychosis, but affective factors and attachment style are less commonly considered. Research should be conducted into the effectiveness of psychological therapies which calibrate cognitive and affective interventions, according to attachment style.
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Affiliation(s)
| | - Tess Maguire
- Department of Psychology, University of Southampton, UK
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23
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Begemann MJH, Sommer IE, Brand RM, Oomen PP, Jongeneel A, Berkhout J, Molenaar RE, Wielage NN, Toh WL, Rossell SL, Bell IH. Auditory verbal hallucinations and childhood trauma subtypes across the psychosis continuum: a cluster analysis. Cogn Neuropsychiatry 2022; 27:150-168. [PMID: 33980128 DOI: 10.1080/13546805.2021.1925235] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: A strong link between voice-hearing experience and childhood trauma has been established. The aim of this study was to identify whether there were unique clusters of childhood trauma subtypes in a sample across the clinical spectrum of auditory verbal hallucinations (AVH) and to examine clinical and phenomenological features across these clusters.Methods: Combining two independent international datasets (the Netherlands and Australia), childhood trauma subtypes were examined using hierarchical cluster analysis. Clinical and phenomenological characteristics were compared across emerging clusters using MANOVA and chi-squared analyses.Results: The total sample (n = 413) included 166 clinical individuals with a psychotic disorder and AVH, 122 non-clinical individuals with AVH and 125 non-clinical individuals without AVH. Three clusters emerged: (1) low trauma (n = 299); (2) emotion-focused trauma (n = 71); (3) multi-trauma (n = 43). The three clusters differed significantly on their AVH ratings of amount of negative content, with trend-level effects for loudness, degree of negative content and degree of experienced distress. Furthermore, perceptions of voices being malevolent, benevolent and resistance towards voices differed significantly.Conclusion: The data revealed different types of childhood trauma had different relationships between clinical and phenomenological features of voice-hearing experiences. Thus, implicating different mechanistic pathways and a need for tailored treatment approaches.
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Affiliation(s)
- M J H Begemann
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - I E Sommer
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - R M Brand
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Australia
| | - P P Oomen
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - A Jongeneel
- Department of Clinical Psychology, Amsterdam UMCAmsterdam Public Health research institute, Amsterdam, the Netherlands.,Department of Psychosis Research and Innovation, Parnassia Psychiatric Institute, Den Haag, the Netherlands
| | - J Berkhout
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - R E Molenaar
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - N N Wielage
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - W L Toh
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - S L Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.,Department of Mental Health, St Vincent's Hospital, Melbourne, Australia
| | - I H Bell
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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24
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Fielding-Smith SF, Greenwood KE, Wichers M, Peters E, Hayward M. Associations between responses to voices, distress and appraisals during daily life: an ecological validation of the cognitive behavioural model. Psychol Med 2022; 52:538-547. [PMID: 32646525 DOI: 10.1017/s0033291720002238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cognitive models propose that behavioural responses to voices maintain distress by preventing disconfirmation of negative beliefs about voices. We used Experience Sampling Methodology (ESM) to examine the hypothesized maintenance role of behavioural responses during daily life. METHOD Thirty-one outpatients with frequent voices completed a smartphone-based ESM questionnaire 10 times a day over 9 days, assessing voice-related distress; resistance and compliance responses to voices; voice characteristics (intensity and negative content); appraisals of voice dominance, uncontrollability and intrusiveness. RESULTS In line with predictions, behavioural responses were associated with voice appraisals (dominance and uncontrollability), but not voice characteristics. Greater resistance and compliance were reported in moments of increased voice distress, but these associations did not persist after controlling for concurrent voice appraisals and characteristics. Voice distress was predicted by appraisals, and, unexpectedly, also by voice characteristics. As predicted, compliance and resistance were related to increases in distress at subsequent timepoints, whilst antecedent voice appraisals and characteristics had no such effect. Compliance, but not resistance, additionally predicted subsequent increases in voice uncontrollability. In both cases, the reverse models showed no association, indicating directional effects of responses on subsequent distress, and of compliance on uncontrollability appraisals. CONCLUSIONS These results provide support for the cognitive model by suggesting that momentary behavioural and emotional responses to voices are associated with concurrent negative voice appraisals. Findings suggest that behavioural responses may be driven by voice appraisals, rather than directly by distress, and may in turn maintain voice appraisals and associated distress during the course of daily life.
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Affiliation(s)
| | - Kathryn E Greenwood
- School of Psychology, University of Sussex, Brighton, UK
- Research & Development Department, Sussex Partnership NHS Foundation Trust, Hove, UK
| | - Marieke Wichers
- University of Groningen, University Medical Centre of Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Centre of Groningen, Groningen, the Netherlands
| | - Emmanuelle Peters
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
| | - Mark Hayward
- School of Psychology, University of Sussex, Brighton, UK
- Research & Development Department, Sussex Partnership NHS Foundation Trust, Hove, UK
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25
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Langman-Levy A, Johns L, Palmier-Claus J, Sacadura C, Steele A, Larkin A, Murphy E, Bowe S, Morrison A. Adapting cognitive behavioural therapy for adolescents with psychosis: insights from the Managing Adolescent first episode in psychosis study (MAPS). PSYCHOSIS 2022; 15:28-43. [PMID: 36866165 PMCID: PMC9970186 DOI: 10.1080/17522439.2021.2001561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background Onset of psychosis commonly occurs in adolescence, and long-term prognosis can be poor. There is growing evidence, largely from adult cohorts, that Cognitive Behavioural Therapy for Psychosis (CBTp) and Family Interventions (FI) can play a role in managing symptoms and difficulties associated with psychosis. However, adolescents have distinct developmental needs that likely impact their engagement and response to talking therapy. There is limited guidance on adapting CBTp to meet the clinical needs of under-eighteens experiencing psychosis. Method This educational clinical practice article details learnings from therapists and supervisors working with young people (aged 14-18 years) with psychosis during the Managing Adolescent first-episode Psychosis: a feasibility Study (MAPS) randomised clinical treatment trial, supplemented by findings from nested qualitative interviews with young people receiving CBTp. Results Suggested are given for tailoring CBTp assessment, formulation and interventions to meet the developmental and clinical needs of adolescents with psychosis. Developmentally appropriate techniques and resources described. Conclusions Early indications from MAPS study indicate this developmentally tailored approach is an acceptable, safe and helpful treatment for young people with psychosis. Further research is needed to develop empirically grounded and evaluated CBTp for adolescents.
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Affiliation(s)
- Amy Langman-Levy
- Early Intervention in Psychosis Service, Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Louise Johns
- Early Intervention in Psychosis Service, Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK,Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK,CONTACT Louise Johns Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford OX3 7JX, UK
| | - Jasper Palmier-Claus
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK,Research and Development Department, Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - Catarina Sacadura
- Research and Development Department, Sussex Partnership NHS Foundation Trust, Sussex, UK
| | - Ann Steele
- Research and Development Department, Sussex Partnership NHS Foundation Trust, Sussex, UK
| | - Amanda Larkin
- Psychosis Research Unit, Greater Manchester Health NHS Foundation Trust, Manchester, UK
| | - Elizabeth Murphy
- Psychosis Research Unit, Greater Manchester Health NHS Foundation Trust, Manchester, UK
| | - Samantha Bowe
- Psychosis Research Unit, Greater Manchester Health NHS Foundation Trust, Manchester, UK
| | - Anthony Morrison
- Psychosis Research Unit, Greater Manchester Health NHS Foundation Trust, Manchester, UK,Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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26
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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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27
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Hjelmervik H, Craven AR, Johnsen E, Kompus K, Bless JJ, Sinkeviciute I, Kroken RA, Løberg EM, Ersland L, Grüner R, Sommer IE, Hugdahl K. Negative valence of hallucinatory voices as predictor of cortical glutamatergic metabolite levels in schizophrenia patients. Brain Behav 2022; 12:e2446. [PMID: 34874613 PMCID: PMC8785643 DOI: 10.1002/brb3.2446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/24/2021] [Accepted: 10/26/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Negative emotional valence of auditory verbal hallucinations (AVHs) in schizophrenia can be a source of distress and is considered a strong predictor of illness severity. Previous studies have found glutamate to mediate AVH severity in frontal and temporal brain regions, however, they do not specifically address emotional valence of AVH. The role of glutamate for the experience of negative- versus positive emotional valence of AVH is therefore unknown and was investigated in the current study. METHODS Using magnetic resonance spectroscopy (MRS), 37 schizophrenia patients had Glx (glutamate+glutamine) measured in the left superior temporal gyrus (STG), and additionally in the anterior cingulate cortex (ACC) and the right STG, or in the left inferior frontal gyrus (IFG). Self-reported emotional valence in AVH was measured with the Beliefs About Voices Questionnaire (BAVQ-R). RESULTS Results from linear mixed models showed that negative emotional valence was associated with reduced Glx levels across all four measured brain regions in the frontal and temporal lobe. More specifically, voices that were experienced to be omnipotent (p = 0.04) and that the patients attempted to resist (p = 0.04) were related to lower Glx levels. Follow-up analysis of the latter showed that voices that evoked emotional resistance (i.e., fear, sadness, anger), rather than behavioral resistance, was a significant predictor of reduced glutamate (p = 0.02). CONCLUSION The findings could indicate aberrant glutamatergic signaling, or increased NMDA-receptor hypoactivity in patients who experience their voices to be more emotionally negative. Overall, the study provides support for the glutamate hypothesis of schizophrenia.
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Affiliation(s)
- Helene Hjelmervik
- School of Health Sciences, Kristiania University college, Bergen, Norway.,Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Alexander R Craven
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,NORMENT Center of Excellence, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Engineering, Haukeland University Hospital, Bergen, Norway
| | - Erik Johnsen
- NORMENT Center of Excellence, Haukeland University Hospital, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine (K1), University of Bergen, Norway
| | - Kristiina Kompus
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Josef J Bless
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Igne Sinkeviciute
- NORMENT Center of Excellence, Haukeland University Hospital, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine (K1), University of Bergen, Norway
| | - Rune A Kroken
- NORMENT Center of Excellence, Haukeland University Hospital, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine (K1), University of Bergen, Norway
| | - Else-Marie Løberg
- NORMENT Center of Excellence, Haukeland University Hospital, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Lars Ersland
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,NORMENT Center of Excellence, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Engineering, Haukeland University Hospital, Bergen, Norway
| | - Renate Grüner
- NORMENT Center of Excellence, Haukeland University Hospital, Bergen, Norway.,Department of Radiology, Haukeland University Hospital, Bergen, Norway.,Department of Physics and Technology, University of Bergen, Bergen, Norway
| | - Iris E Sommer
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Kenneth Hugdahl
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Radiology, Haukeland University Hospital, Bergen, Norway
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28
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Kamp KS, Steffen EM, Moskowitz A, Spindler H. Sensory experiences of one's deceased spouse in older adults: An analysis of predisposing factors. Aging Ment Health 2022; 26:140-148. [PMID: 33143459 DOI: 10.1080/13607863.2020.1839865] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objectives This study focuses on pre-disposing factors associated with sensory experiences of the deceased (SED), also called bereavement hallucinations. Even though SED are common among older widowed adults, our knowledge of these experiences is still limited.Method Survey responses were obtained from 310 older widowed participants (M = 70.05 ± 8.39), complemented with data from Danish national registers.Results Hierarchical logistic regression analysis revealed four significant pre-disposing factors: prior experiences of SED in the context of previous significant bereavements (OR = 4.72), a history of interpersonal trauma (OR = 5.8), high pre-death relationship closeness (OR = 2.76) and stronger religious/spiritual worldview (OR = 1.12). No association to registered mental health diagnosis was identified.Conclusion: SED may be considered an interpersonal experience, which may be more likely to occur if the pre-death relationship is described as very close and if the bereaved has previously experienced interpersonal trauma. We argue that SED should not necessarily be considered an indication of neurodegenerative or psychiatric diseases.
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Affiliation(s)
- Karina Stengaard Kamp
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | | | | | - Helle Spindler
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark.,Centre for Integrated Register-Based Research, Aarhus University, Aarhus, Denmark
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29
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Strawson WH, Wang HT, Quadt L, Sherman M, Larsson DEO, Davies G, Mckeown BLA, Silva M, Fielding-Smith S, Jones AM, Hayward M, Smallwood J, Critchley HD, Garfinkel SN. Voice Hearing in Borderline Personality Disorder Across Perceptual, Subjective, and Neural Dimensions. Int J Neuropsychopharmacol 2021; 25:375-386. [PMID: 34940826 PMCID: PMC9154289 DOI: 10.1093/ijnp/pyab093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 11/24/2021] [Accepted: 12/23/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Auditory verbal hallucinations (AVH) commonly occur in the context of borderline personality disorder (BPD) yet remain poorly understood. AVH are often perceived by patients with BPD as originating from inside the head and hence viewed clinically as "pseudohallucinations," but they nevertheless have a detrimental impact on well-being. METHODS The current study characterized perceptual, subjective, and neural expressions of AVH by using an auditory detection task, experience sampling and questionnaires, and functional neuroimaging, respectively. RESULTS Perceptually, reported AVH correlated with a bias for reporting the presence of a voice in white noise. Subjectively, questionnaire measures indicated that AVH were significantly distressing and persecutory. In addition, AVH intensity, but not perceived origin (i.e., inside vs outside the head), was associated with greater concurrent anxiety. Neurally, fMRI of BPD participants demonstrated that, relative to imagining or listening to voices, periods of reported AVH induced greater blood oxygenation level-dependent activity in anterior cingulate and bilateral temporal cortices (regional substrates for language processing). AVH symptom severity was associated with weaker functional connectivity between anterior cingulate and bilateral insular cortices. CONCLUSION In summary, our results indicate that AVH in participants with BPD are (1) underpinned by aberrant perceptual-cognitive mechanisms for signal detection, (2) experienced subjectively as persecutory and distressing, and (3) associated with distinct patterns of neural activity that inform proximal mechanistic understanding. Our findings are like analogous observations in patients with schizophrenia and validate the clinical significance of the AVH experience in BPD, often dismissed as "pseudohallucinations." These highlight a need to reconsider this experience as a treatment priority.
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Affiliation(s)
- Will H Strawson
- Correspondence: Will H. Strawson, MSci, Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, BN1 9RY, UK ()
| | - Hao-Ting Wang
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK,Sackler Centre for Consciousness Science, Falmer, UK
| | - Lisa Quadt
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK,Sackler Centre for Consciousness Science, Falmer, UK
| | - Maxine Sherman
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK,Sackler Centre for Consciousness Science, Falmer, UK,Department of Informatics, University of Sussex, UK
| | - Dennis E O Larsson
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK,Department of Psychology, Falmer, UK,Leverhulme Trust London, UK
| | - Geoff Davies
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK,University of Sussex, Falmer, UK,Sussex Partnership NHS Foundation Trust, Brighton, UK
| | | | - Marta Silva
- Cognition and Brain Plasticity Unit, Barcelona, Catalunya, Spain,Institute of Neurosciences, University of Barcelona, Catalunya, Spain
| | - Sarah Fielding-Smith
- University of Sussex, Falmer, UK,Sussex Partnership NHS Foundation Trust, Brighton, UK,Oxford Health NHS Foundation Trust, Oxford, UK,Oxford Institute of Clinical Psychology Training and Research, Oxford, UK
| | - Anna-Marie Jones
- University of Sussex, Falmer, UK,Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Mark Hayward
- Department of Psychology, Falmer, UK,University of Sussex, Falmer, UK,Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Jonathan Smallwood
- Department of Psychology, University of York, York, UK,Department of Psychology, Queen’s University, Kingston, ON, Canada
| | - Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK,Sackler Centre for Consciousness Science, Falmer, UK,University of Sussex, Falmer, UK,Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Sarah N Garfinkel
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK,University of Sussex, Falmer, UK,Sussex Partnership NHS Foundation Trust, Brighton, UK,Institute of Cognitive Neuroscience, University College London, London, UK
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30
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Zanello A, Dugré JR. Preliminary Evidence for Heterogeneity of Beliefs About Auditory Verbal Hallucinations Intent. J Nerv Ment Dis 2021; 209:872-878. [PMID: 34846355 DOI: 10.1097/nmd.0000000000001391] [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: 11/26/2022]
Abstract
ABSTRACT Perceptions of patient's auditory verbal hallucinations (AVHs), commonly termed voices, have important impacts on their everyday lives. Despite research emphasizing the consequences of malevolent voices, preliminary results suggest that beliefs about voices may not be mutually exclusive. As such, we aimed to characterize the heterogeneity of beliefs about AVHs and describe their clinical correlates. We recruited 78 patients referred to a Voices group therapy for refractory and distressing voices. Based on the Revised Beliefs About Voices Questionnaire, clustering analysis yielded four subgroups of patients with distinct pattern of beliefs about AVHs. These subgroups differed significantly in terms of affective disturbances, engagement, and resistance to their voices. Furthermore, no significant changes in beliefs about voices were observed after 6 weeks. Results of the current study suggest that the heterogeneity regarding the beliefs about AVHs should be targeted in treatment to reduce their associated negative outcomes.
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Affiliation(s)
- Adriano Zanello
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
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31
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Liang N, Li X, Liu S, Liu Y, Zhao W, Wen Y, Li Q, Guo J, Xu Y. Effects of virtual reality-based computer avatar therapy system on auditory verbal hallucinations assessed using functional near-infrared spectroscopy: A two-patient case study. Psychiatry Res 2021; 305:114150. [PMID: 34461355 DOI: 10.1016/j.psychres.2021.114150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/30/2021] [Accepted: 07/31/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Nana Liang
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Jiefang nan road, Taiyuan, 030001, China
| | - Xinrong Li
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Jiefang nan road, Taiyuan, 030001, China; Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorders, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Sha Liu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Jiefang nan road, Taiyuan, 030001, China; Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorders, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yao Liu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Jiefang nan road, Taiyuan, 030001, China
| | - Wentao Zhao
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Jiefang nan road, Taiyuan, 030001, China; Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorders, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yujiao Wen
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Jiefang nan road, Taiyuan, 030001, China
| | - Qiqi Li
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Jiefang nan road, Taiyuan, 030001, China
| | - Jianxia Guo
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Jiefang nan road, Taiyuan, 030001, China
| | - Yong Xu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Jiefang nan road, Taiyuan, 030001, China; Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorders, First Hospital of Shanxi Medical University, Taiyuan, China; Department of Mental Health, Shanxi Medical University, Taiyuan, China.
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Barnes GL, Garety PA, Emsley R, Jameel L, Hardy A. Is there an association between caregiver antipathy and psychosis? A systematic review. Psychol Psychother 2021; 94:798-821. [PMID: 33595172 DOI: 10.1111/papt.12328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/22/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Existing reviews of trauma and psychosis have identified associations between childhood emotional abuse (CEA) and psychosis. However, conceptual issues relating to assessment of CEA limit the conclusions that can be drawn from the literature. The aim of this review was to identify and evaluate studies reporting an association between childhood experiences of caregiver antipathy (i.e. criticism, hostility, coldness, or rejection from a parental figure experienced prior to age 17 years) and psychosis symptoms/diagnosis. METHODS Five databases were systematically searched for articles published until May 2020. Studies were evaluated against inclusion/exclusion criteria, and a narrative synthesis of findings was completed. Study quality was assessed by two independent raters. RESULTS Fourteen studies comprised of 1,848 participants met inclusion criteria. Twelve of these studies found significant associations between caregiver antipathy and psychosis, and two did not. There was evidence that adults with schizophrenia-spectrum diagnoses report more severe caregiver antipathy in childhood than non-clinical controls and that caregiver antipathy severity is positively correlated with psychosis symptom severity. Most studies received weak or moderate quality ratings and all used cross-sectional or case-control designs which showed associations, rather than causal relationships, between childhood caregiver antipathy and later psychosis. CONCLUSIONS Future research would benefit from more rigorous and valid assessment of CEA, use of multivariate methods to account for possible patterns of co-occurrence, and longitudinal study designs to make more robust causal claims. The findings may have important implications for the delivery of psychological care for people with psychosis who report adverse caregiving experiences. PRACTITIONER POINTS People with schizophrenia-spectrum diagnoses may report more severe caregiver antipathy in childhood than non-clinical controls. Caregiver antipathy severity appears to be positively correlated with psychosis symptom severity in clinical and non-clinical populations. Clinicians should consider the possible impact of caregiver antipathy on psychosis symptoms, their content and distress maintenance. Clinicians should also recognise the potential impact of adverse caregiving experiences on therapeutic relationships, patterns of help-seeking and service engagement. Best practice in clinical services would be to adopt individual, formulation-based approaches within trauma-informed models of care.
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Affiliation(s)
- Georgina L Barnes
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, UK.,South London & Maudsley NHS Trust, Maudsley Hospital, London, UK
| | - Philippa A Garety
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, UK.,South London & Maudsley NHS Trust, Maudsley Hospital, London, UK
| | - Richard Emsley
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Leila Jameel
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, UK.,South London & Maudsley NHS Trust, Maudsley Hospital, London, UK
| | - Amy Hardy
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, UK.,South London & Maudsley NHS Trust, Maudsley Hospital, London, UK
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Increasing access to cognitive–behavioural therapy for patients with psychosis by evaluating the feasibility of a randomised controlled trial of brief, targeted cognitive–behavioural therapy for distressing voices delivered by assistant psychologists: the GiVE2 trial. BJPsych Open 2021. [PMCID: PMC8388007 DOI: 10.1192/bjo.2021.983] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
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 sites, with 1:1:1 allocation and blind post-treatment and follow-up assessments.
Results
Feasibility outcomes were favourable with regard to the recruitment and retention of participants and the adherence of assistant psychologists to therapy and supervision protocols. For the candidate primary outcomes, estimated effects were in favour of GiVE compared with supportive counselling and treatment as usual at post-treatment. At follow-up, estimated effects were in favour of supportive counselling compared with GiVE and treatment as usual, and GiVE compared with treatment as usual.
Conclusions
A definitive trial of the GiVE intervention, delivered by assistant psychologists, is feasible. Adaptations to the GiVE intervention and the design of any future trials may be necessary.
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Hayward M, Jones AM, Strawson WH, Quadt L, Larsson DEO, Silva M, Davies G, Fielding-Smith S, Hazell CM, Critchley HD, Garfinkel SN. A cross-sectional study of auditory verbal hallucinations experienced by people with a diagnosis of borderline personality disorder. Clin Psychol Psychother 2021; 29:631-641. [PMID: 34322956 DOI: 10.1002/cpp.2655] [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: 04/17/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND The presence of auditory verbal hallucinations (AVHs) does not currently feature in the main diagnostic criteria for borderline personality disorder (BPD). However, there is accumulating evidence that a high proportion of BPD patients report longstanding and frequent AVHs which constitute a significant risk factor for suicide plans and attempts, and hospitalization. AIM This study addressed questions about the validity and phenomenology of AVHs in the context of BPD. The longer-term aim is to facilitate the development and translation of treatment approaches to address the unmet need of this population. METHOD This was a cross-sectional study, combining phenomenological and psychological assessments administered in person and online. We explored the experiences of 48 patients with a diagnosis of BPD who were hearing AVHs. RESULTS Participants gave 'consistent' reports on the measure of AVH phenomenology, suggesting that these experiences were legitimate. Similar to AVHs in a psychosis context, AVHs were experienced as distressing and appraised as persecutory. AVHs were found to be weakly associated with BPD symptoms. AVHs were also rated highly as a treatment priority by the majority of participants. CONCLUSION The findings suggest that AVH is a legitimate and distressing symptom of BPD and a treatment priority for some patients. The relative independence of AVHs from other BPD symptoms and emotional states suggests that psychological treatment may need to be targeted specifically at the symptom of AVHs. This treatment could be adapted from cognitive behaviour therapy, the psychological intervention that is recommended for the treatment of AVHs in the context of psychosis.
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Affiliation(s)
- Mark Hayward
- Sussex Partnership NHS Foundation Trust, Brighton, UK.,Department of Psychology, University of Sussex, Falmer, UK
| | | | - Will H Strawson
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK.,Department of Psychology, University of Sussex, Falmer, UK
| | - Lisa Quadt
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK.,Sackler Centre for Consciousness Science, University of Sussex, Falmer, UK.,Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Dennis E O Larsson
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK.,Department of Psychology, University of Sussex, Falmer, UK.,Leverhulme Trust, London, UK
| | - Marta Silva
- Cognition and Brain Plasticity Unit, University of Barcelona, Barcelona, Spain.,Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Geoff Davies
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK.,Department of Psychology, University of Sussex, Falmer, UK
| | | | - Cassie M Hazell
- Social Sciences Department, University of Westminster, London, UK
| | - Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK.,Sackler Centre for Consciousness Science, University of Sussex, Falmer, UK.,Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Sarah N Garfinkel
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK.,Sussex Partnership NHS Foundation Trust, Brighton, UK.,Institute of Cognitive Neuroscience, University College London, London, UK
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Garety P, Edwards CJ, Ward T, Emsley R, Huckvale M, McCrone P, Rus-Calafell M, Fornells-Ambrojo M, Gumley A, Haddock G, Bucci S, McLeod H, Hardy A, Peters E, Myin-Germeys I, Craig T. Optimising AVATAR therapy for people who hear distressing voices: study protocol for the AVATAR2 multi-centre randomised controlled trial. Trials 2021; 22:366. [PMID: 34034792 PMCID: PMC8145186 DOI: 10.1186/s13063-021-05301-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/28/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND AVATAR therapy is a novel intervention targeting distressing auditory verbal hallucinations (henceforth 'voices'). A digital simulation (avatar) of the voice is created and used in a three-way dialogue between participant, avatar and therapist. To date, therapy has been delivered over 6 sessions, comprising an initial phase, focusing on standing up to a hostile avatar, and a second phase in which the avatar concedes and focus shifts to individualised treatment targets, including beliefs about voices. The first fully powered randomised trial found AVATAR therapy resulted in a rapid and substantial fall in voice frequency and associated distress that was superior to supportive counselling at 12 weeks. The main objective of this AVATAR2 trial is to test the efficacy of two forms of AVATAR therapy in reducing voice-related distress: AVATAR-brief (standardised focus on exposure, assertiveness and self-esteem) and AVATAR-extended (phase 1 mirroring AVATAR-brief augmented by a formulation-driven phase 2). Secondary objectives include the examination of additional voice, wellbeing and mood outcomes, the exploration of mediators and moderators of therapy response, and examining cost-effectiveness of both forms of therapy compared with usual treatment (TAU). METHODS This multi-site parallel group randomised controlled trial will independently randomise 345 individuals to receive AVATAR-brief (6 sessions) plus TAU or AVATAR-extended (12 sessions) plus TAU or TAU alone (1:1:1 allocation). Participants will be people with a diagnosis of schizophrenia spectrum and other psychotic disorders who have heard distressing voices for more than 6 months. The primary outcome is the PSYRATS Auditory Hallucinations Distress dimension score at 16 and 28 weeks, conducted by blinded assessors. Statistical analysis will follow the intention-to-treat principle and data will be analysed using linear mixed models. Mediation and moderation analyses using contemporary causal inference methods will be conducted as secondary analyses. Service costs will be calculated, and cost-effectiveness assessed in terms of quality-adjusted life years accrued. DISCUSSION This study will clarify optimal therapy delivery, test efficacy in a multi-site study and enable the testing of the AVATAR software platform, therapy training and provision in NHS settings. TRIAL REGISTRATION ISRCTN registry ISRCTN55682735 . Registered on 22 January 2020. The trial is funded by the Wellcome Trust (WT).
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Affiliation(s)
- Philippa Garety
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, London, UK
| | - Clementine J Edwards
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- South London & Maudsley NHS Foundation Trust, London, UK.
| | - Thomas Ward
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, London, UK
| | - Richard Emsley
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | | | - Mar Rus-Calafell
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Miriam Fornells-Ambrojo
- University College London, London, UK
- South London & Maudsley NHS Foundation Trust, London, UK
| | - Andrew Gumley
- University of Glasgow, Glasgow, UK
- NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Gillian Haddock
- University of Manchester and the Manchester Academic Health Sciences Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust and the Manchester Academic Health Sciences Centre, Manchester, UK
| | - Sandra Bucci
- University of Manchester and the Manchester Academic Health Sciences Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust and the Manchester Academic Health Sciences Centre, Manchester, UK
| | - Hamish McLeod
- University of Glasgow, Glasgow, UK
- NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Amy Hardy
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, London, UK
| | - Emmanuelle Peters
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, London, UK
| | | | - Thomas Craig
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, London, UK
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Kamp KS, Steffen EM, Moskowitz A, Spindler H. Prevalence and Phenomenology of Sensory Experiences of a Deceased Spouse: A Survey of Bereaved Older Adults. OMEGA-JOURNAL OF DEATH AND DYING 2021; 87:103-125. [PMID: 34018434 DOI: 10.1177/00302228211016224] [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] [Indexed: 11/16/2022]
Abstract
Sensory and quasi-sensory experiences of the deceased (SED), also called bereavement hallucinations, are common in bereavement, but research detailing these experiences is limited. Methods: An in-depth survey of SED was developed based on existing research, and 310 older adults from the general Danish population participated in the study 6-10 months after their spouse died. Results: SED were reported by 42% of the participants with wide-ranging phenomenological features across sensory-modalities. In particular, seeing and hearing the deceased spouse was experienced as very similar to the couple's everyday contacts before death. SED were endorsed as positive by a majority of experiencers, and the experiences were often shared with family and friends. Discussion: SED are conceptualized as social and relational phenomena, which may comfort the surviving spouse in late-life bereavement, but also provide tangible help to some experiencers. In clinical practice, SED may be considered a potential resource for the therapeutic grief process.
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Affiliation(s)
- Karina S Kamp
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - Edith Maria Steffen
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - Andrew Moskowitz
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - Helle Spindler
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
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O'Brien C, Rus-Calafell M, Craig TK, Garety P, Ward T, Lister R, Fornells-Ambrojo M. Relating behaviours and therapeutic actions during AVATAR therapy dialogue: An observational study. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 60:443-462. [PMID: 33949726 DOI: 10.1111/bjc.12296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/08/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES AVATAR therapy is a novel relational approach to working with distressing voices by engaging individuals in direct dialogue with a digital representation of their persecutory voice (the avatar). Critical to this approach is the avatar transition from abusive to conciliatory during the course of therapy. To date, no observational study has examined the moment-to-moment dialogical exchanges of this innovative therapy. We aim to (1) map relating behaviours between participants and their created avatars and (2) examine therapeutic actions delivered within AVATAR dialogue. METHOD Twenty-five of the fifty-three AVATAR therapy completers were randomly selected from a randomized controlled trial (Craig et al. The Lancet Psychiatry, 5, 2018 and 31). Seventy-five audio recordings of active dialogue from sessions 1 and 4 and the last session were transcribed and analysed using a newly developed coding frame. Inter-rater reliability was good to excellent. RESULTS Fine-grained analysis of 4,642 observations revealed nuanced communication around relational power and therapeutic activity. Early assertiveness work, reinforced by the therapist, focussed on increasing power and distancing. Participants' submissive behaviours reduced during therapy, but the shift was gradual. Once the transition to a more conciliatory tone took place, the dialogue primarily involved direct communication between participant and avatar, focussing on sense of self and developmental and relational understanding of voices. CONCLUSIONS AVATAR therapy supports voice-hearers in becoming more assertive towards a digital representation of their abusive voice. Direct dialogue with carefully characterized avatars aims to build the voice-hearers' positive sense of self, supporting the person to make sense of their experiences. PRACTITIONER POINTS AVATAR therapy enables voice-hearers to engage in face-to-face dialogue with a digital representation ('avatar') of their persecutory voice. Fine-grained analyses showed how relating behaviours and therapeutic actions evolve during active AVATAR therapy dialogue. Carefully characterized avatars and direct therapist input help voice-hearers become more assertive over the avatar, enhance positive sense of self, and support individuals to make sense of their experiences.
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Affiliation(s)
- Conan O'Brien
- Research Department of Clinical, Educational and Health Psychology, University College London, UK.,East London NHS Foundation Trust, London, UK
| | - Mar Rus-Calafell
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany.,Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Tom Kj Craig
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Philippa Garety
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,South London & Maudsley NHS Foundation Trust, UK
| | - Thomas Ward
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,South London & Maudsley NHS Foundation Trust, UK
| | - Rachel Lister
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Miriam Fornells-Ambrojo
- Research Department of Clinical, Educational and Health Psychology, University College London, UK.,North East London NHS Foundation Trust, UK
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The Application of Maultsby’s Rational Behavior Therapy in Psychosis – A Case Report. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2021. [DOI: 10.1007/s10942-021-00391-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractThe purpose of this paper is to present the applicability of Rational Behavior Therapy (RBT) for a patient with psychosis. RBT is a form of cognitive-behavioral therapy developed by an American psychiatrist, Maxie C. Maultsby, Jr. RBT teaches rational self-counseling to achieve emotive and behavioral goals, reduce distress and the symptoms of the disease, improve functioning, improve treatment adherence, and prevent relapse. The challenges in applying cognitive behavior therapy in psychosis are described. We report the case of a 17-year-old patient who had been recently diagnosed with schizophrenia according to ICD-10 criteria, presenting with recurrent psychotic symptoms and suicidal ideation. Over 1.5 years, the patient was treated in an outpatient setting with antipsychotic medications and, intermittently, with RBT-based psychotherapy (by the first author). The therapy process was interrupted periodically due to temporary improvements in the patient’s status, non-adherence, or relapses, including one episode requiring hospitalization. Nevertheless, the treatment eventually resulted in a long-lasting remission. We present examples of the RBT techniques used in this therapeutic process and highlight this treatment modality’s unique features which support patients utilizing rational self-counseling skills to become more independent in coping with their problems. We emphasize that patients with a mental illness like schizophrenia or bipolar disorder also suffer from learned emotional disturbances that are amenable to treatment with cognitive-behavior therapies like RBT. In conclusion, we submit that with its self-counseling properties, RBT offers non-intrusive ways of helping people experiencing psychotic symptoms as part of their diagnosis and in prodromal or non-diagnostic states.
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Ward T, Lister R, Fornells-Ambrojo M, Rus-Calafell M, Edwards CJ, O'Brien C, Craig TKJ, Garety P. The role of characterisation in everyday voice engagement and AVATAR therapy dialogue. Psychol Med 2021; 52:1-8. [PMID: 33827728 PMCID: PMC9811344 DOI: 10.1017/s0033291721000659] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Voices are commonly experienced as communication with a personified 'other' with ascribed attitudes, intentionality and personality (their own 'character'). Phenomenological work exploring voice characterisation informs a new wave of relational therapies. To date, no study has investigated the role of characterisation in behavioural engagement with voices or within psychological therapy for distressing voices. METHODS Baseline characterisation (the degree to which the voice is an identifiable and characterful entity) of the dominant voice was rated (high, medium or low) using a newly developed coding framework, for n = 60 people prior to starting AVATAR therapy. Associations between degree of characterisation and (i) everyday behavioural engagement with voices (The Beliefs about Voices Questionnaire-Revised; n = 60); and (ii) interaction within avatar dialogue [Session 4 Time in Conversation (participant-avatar); n = 45 therapy completers] were explored. RESULTS Thirty-three per cent reported high voice characterisation, 42% medium and 25% low. There was a significant association between characterisation and behavioural engagement [H(2) = 7.65, p = 0.022, ɛ2 = 0.130] and duration of participant-avatar conversation [F(2,42) = 6.483, p = 0.004, η2 = 0.236]. High characterisation was associated with increased behavioural engagement compared with medium (p = 0.004, r = 0.34; moderate effect) and low (p = 0.027, r = 0.25; small-moderate effect) with a similar pattern observed for the avatar dialogue [high v. medium: p = 0.008, Hedges' g = 1.02 (large effect); high v. low: p = 0.023, Hedges' g = 1.03 (large effect)]. No differences were observed between medium and low characterisation. DISCUSSION Complex voice characterisation is associated with how individuals interact with their voice(s) in and out of therapy. Clinical implications and future directions for AVATAR therapy and other relational therapies are discussed.
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Affiliation(s)
- Thomas Ward
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, London, UK
| | - Rachel Lister
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Miriam Fornells-Ambrojo
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Mar Rus-Calafell
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Clementine J. Edwards
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, London, UK
| | - Conan O'Brien
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Tom KJ Craig
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Philippa Garety
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, London, UK
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Tsang A, Bucci S, Branitsky A, Kaptan S, Rafiq S, Wong S, Berry K, Varese F. The relationship between appraisals of voices (auditory verbal hallucinations) and distress in voice-hearers with schizophrenia-spectrum diagnoses: A meta-analytic review. Schizophr Res 2021; 230:38-47. [PMID: 33667857 DOI: 10.1016/j.schres.2021.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/05/2021] [Accepted: 02/14/2021] [Indexed: 02/01/2023]
Abstract
Cognitive-behavioural models of auditory verbal hallucinations (voices) predict that the interpretation of voices determines the levels of distress experienced by voice-hearers. Examining the contribution of these voice appraisals is central to the delivery of effective psychological interventions for the management of distressing psychotic symptoms. This meta-analysis synthesised evidence from studies that tested the relationship between a range of appraisals and several distress measures (voice-related and emotional distress) in individuals with schizophrenia-spectrum diagnoses. A database search (PsycINFO, PubMed and Web of Science) was conducted for articles published up to August 2020. Twenty-eight eligible studies, comprising of 1497 clinical participants examined the association between eight voice appraisals and distress. Moderate to large summary effects (r ranging between 0.30 and 0.50) were observed in several analyses focusing on 'maladaptive' appraisals and beliefs about voices (malevolence, power, metaphysical beliefs, beliefs about loss of control, voice intrusiveness), with voice dominance having a large summary effect, r = 0.58, 95% CI [0.43, 0.69]. Positive appraisals and beliefs had small negative summary effects on distress. The magnitude of the observed effects was similar across subgroup analyses considering measures of voice-related distress, anxiety and depression. The findings of this evidence synthesis broadly corroborate cognitive-behavioural models of distressing voices, but suggested that factors other than voice appraisals may also predict the distress and impairment caused by hallucinatory experiences in people with schizophrenia-spectrum disorders. Nonetheless, our findings confirm that voice appraisals are an important and meaningful target for treatment in help-seeking voice hearers with psychosis.
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Affiliation(s)
- Anthony Tsang
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester. 2(nd) Floor, Zochonis Building, Brunswick Street, Manchester M13 9PL, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester. 2(nd) Floor, Zochonis Building, Brunswick Street, Manchester M13 9PL, UK; Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Alison Branitsky
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Safa Kaptan
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester. 2(nd) Floor, Zochonis Building, Brunswick Street, Manchester M13 9PL, UK
| | - Sonya Rafiq
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester. 2(nd) Floor, Zochonis Building, Brunswick Street, Manchester M13 9PL, UK
| | - Samantha Wong
- Salford Royal NHS Foundation Trust Unit, Manchester Academic Health Science Centre, Salford, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester. 2(nd) Floor, Zochonis Building, Brunswick Street, Manchester M13 9PL, UK; Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester. 2(nd) Floor, Zochonis Building, Brunswick Street, Manchester M13 9PL, UK; Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
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Bortolon C, Brand RM, Altman R, Matos M. Beyond trauma: the contribution of characteristics of shame memories, shame, and self-criticism to voice-hearing proneness. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01438-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Longden E, Corstens D, Pyle M, Emsley R, Peters S, Chauhan N, Dehmahdi N, Morrison AP. Engaging dialogically with auditory hallucinations: design, rationale and baseline sample characteristics of the Talking With Voices pilot trial. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2021. [DOI: 10.1080/17522439.2021.1884740] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Eleanor Longden
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Division of Psychology and Mental Health; School of Health Sciences; Faculty of Biology, Medicine and Health; Manchester Academic Health Science Centre; the University of Manchester, Manchester, UK
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Dirk Corstens
- GGZ Noord-Holland Noord, Texel/den Helder, The Netherlands
| | - Melissa Pyle
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Sarah Peters
- Division of Psychology and Mental Health; School of Health Sciences; Faculty of Biology, Medicine and Health; Manchester Academic Health Science Centre; the University of Manchester, Manchester, UK
| | - Nisha Chauhan
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Nikki Dehmahdi
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Anthony P. Morrison
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Division of Psychology and Mental Health; School of Health Sciences; Faculty of Biology, Medicine and Health; Manchester Academic Health Science Centre; the University of Manchester, Manchester, UK
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43
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Badcock JC, Brand R, Thomas N, Hayward M, Paulik G. Multimodal versus unimodal auditory hallucinations in clinical practice: Clinical characteristics and treatment outcomes. Psychiatry Res 2021; 297:113754. [PMID: 33524774 DOI: 10.1016/j.psychres.2021.113754] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 01/21/2021] [Indexed: 12/17/2022]
Abstract
Psychological treatments for hallucinations typically target auditory verbal hallucinations (AVH) but neglect the influence of hallucinations in other sensory modalities. This study compared the baseline clinical characteristics and therapeutic outcomes (following brief Coping Strategy Enhancement) of adult clients (N = 100) with multimodal or unimodal (auditory) hallucinations attending an outpatient service for distressing AVH. The results showed that 72.1% of clients reported multimodal hallucinations in the past month. Group comparisons of most baseline clinical characteristics (AVH features, beliefs about AVH, number of traumatic events, personal and social functioning, negative affect) were non-significant. However, in the subgroup (N = 65) reporting ongoing effects of traumatic events, those with multimodal hallucinations reported significantly higher posttraumatic stress symptoms (d = 0.62). Notably, both multimodal and unimodal hallucination groups showed improvement in AVH distress and frequency post-treatment, but group differences in treatment outcomes were not significant. These findings, in a naturalistic service setting, confirm that multimodal hallucinations are common in people seeking help for distressing AVH and may be associated with higher levels of posttraumatic stress symptoms. Importantly, they also suggest that psychological therapy may be suitable and effective for clients experiencing AVH - irrespective of the presence of hallucinations in other sensory modalities.
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Affiliation(s)
- Johanna C Badcock
- Perth Voices Clinic, Murdoch, WA 6150, Australia; School of Psychological Science, University of Western Australia, Crawley, WA 6009, Australia.
| | - Rachel Brand
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
| | - Mark Hayward
- School of Psychology, University of Sussex, Brighton, United Kingdom; Research & Development Department, Sussex Partnership NHS Foundation Trust, United Kingdom
| | - Georgie Paulik
- Perth Voices Clinic, Murdoch, WA 6150, Australia; School of Psychological Science, University of Western Australia, Crawley, WA 6009, Australia; School of Psychology and Exercise Science, Murdoch University, Murdoch, WA 6150, Australia
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44
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So SHW, Chung LKH, Tse CY, Chan SSM, Chong GHC, Hung KSY, Sommer IEC. Moment-to-moment dynamics between auditory verbal hallucinations and negative affect and the role of beliefs about voices. Psychol Med 2021; 51:661-667. [PMID: 31907105 DOI: 10.1017/s0033291719003611] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Negative affect (NA) has been suggested to be both an antecedent and a consequence of auditory verbal hallucinations (AVH). Furthermore, negative appraisals of voices have been theorized to contribute to the maintenance of AVH. Using the experience sampling method (ESM), this study examined the bi-directional relationship between NA and AVH, and the moderating effect of negative beliefs about voices. METHODS Forty-seven patients diagnosed with schizophrenia spectrum disorders with frequent AVH completed a clinical interview, followed by ESM for 10 times a day over 6 days on an electronic device. Time-lagged analyses were conducted using multilevel regression modeling. Beliefs about voices were assessed at baseline. RESULTS A total of 1654 data points were obtained. NA predicted an increase in AVH in the subsequent moment, and AVH predicted an increase in NA in the subsequent moment. Baseline beliefs about voices as malevolent and omnipotent significantly strengthened the association between NA and AVH within the same moment. In addition, the belief of omnipotence was associated with more hallucinatory experiences in the moment following NA. However, beliefs about voices were not associated directly with momentary levels of NA or AVH. CONCLUSIONS Experiences of NA and AVH drove each other, forming a feedback loop that maintained the voices. The associations between NA and AVH, either within the same moment or across moments, were exacerbated by negative beliefs about voices. Our results suggest that affect-improving interventions may stop the feedback loop and reduce AVH frequency.
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Affiliation(s)
- Suzanne Ho-Wai So
- Department of Psychology, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
| | - Lawrence Kin-Hei Chung
- Department of Psychology, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
| | - Chun-Yu Tse
- Department of Psychology, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
| | - Sandra Sau-Man Chan
- Department of Psychiatry, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
| | | | - Karen Shee-Yueng Hung
- Department of Psychiatry, Castle Peak Hospital, New Territories, Hong Kong SAR, China and
| | - Iris E C Sommer
- Department of Neuroscience and Department of Psychiatry, University Medical Center Groningen, The University of Groningen, Groningen, The Netherlands
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45
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Dellazizzo L, Potvin S, Phraxayavong K, Dumais A. One-year randomized trial comparing virtual reality-assisted therapy to cognitive-behavioral therapy for patients with treatment-resistant schizophrenia. NPJ SCHIZOPHRENIA 2021; 7:9. [PMID: 33580033 PMCID: PMC7881089 DOI: 10.1038/s41537-021-00139-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/09/2020] [Indexed: 01/16/2023]
Abstract
The gold-standard cognitive-behavioral therapy (CBT) for psychosis offers at best modest effects. With advances in technology, virtual reality (VR) therapies for auditory verbal hallucinations (AVH), such as AVATAR therapy (AT) and VR-assisted therapy (VRT), are amid a new wave of relational approaches that may heighten effects. Prior trials have shown greater effects of these therapies on AVH up to a 24-week follow-up. However, no trial has compared them to a recommended active treatment with a 1-year follow-up. We performed a pilot randomized comparative trial evaluating the short- and long-term efficacy of VRT over CBT for patients with treatment-resistant schizophrenia. Patients were randomized to VRT (n = 37) or CBT (n = 37). Clinical assessments were administered before and after each intervention and at follow-up periods up to 12 months. Between and within-group changes in psychiatric symptoms were assessed using linear mixed-effects models. Short-term findings showed that both interventions produced significant improvements in AVH severity and depressive symptoms. Although results did not show a statistically significant superiority of VRT over CBT for AVH, VRT did achieve larger effects particularly on overall AVH (d = 1.080 for VRT and d = 0.555 for CBT). Furthermore, results suggested a superiority of VRT over CBT on affective symptoms. VRT also showed significant results on persecutory beliefs and quality of life. Effects were maintained up to the 1-year follow-up. VRT highlights the future of patient-tailored approaches that may show benefits over generic CBT for voices. A fully powered single-blind randomized controlled trial comparing VRT to CBT is underway.
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Affiliation(s)
- Laura Dellazizzo
- Research center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and addictology, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Stéphane Potvin
- Research center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and addictology, Faculty of Medicine, University of Montreal, Montreal, Canada
| | | | - Alexandre Dumais
- Research center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada.
- Department of Psychiatry and addictology, Faculty of Medicine, University of Montreal, Montreal, Canada.
- Services et Recherches Psychiatriques AD, Montreal, Canada.
- Institut national de psychiatrie légale Philippe-Pinel, Montreal, Canada.
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46
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A relationship of sorts: gender and auditory hallucinations in schizophrenia spectrum disorders. Arch Womens Ment Health 2021; 24:709-720. [PMID: 33743057 PMCID: PMC8492592 DOI: 10.1007/s00737-021-01109-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/25/2021] [Indexed: 10/27/2022]
Abstract
Voice hearing has been conceptualized as an interrelational framework, where the interaction between voice and voice hearer is reciprocal and resembles "real-life interpersonal interactions." Although gender influences social functioning in "real-life situations," little is known about respective effects of gender in the voice hearing experience. One hundred seventeen participants with a schizophrenia spectrum disorder took part in a semi-structured interview about the phenomenology of their voices and completed standardized self-rating questionnaires on their beliefs about their most dominant male and female voices and the power differentials in their respective voice-voice hearer interactions. Additionally, the voice hearers' individual masculine/feminine traits were recorded. Men heard significantly more male than female dominant voices, while the gender ratio of dominant voices was balanced in women. Although basic phenomenological characteristics of voices were similar in both genders, women showed greater amounts of distress caused by the voices and reported a persistence of voices for longer time periods. Command hallucinations that encouraged participants to harm others were predominantly male. Regarding voice appraisals, high levels of traits associated with masculinity (=instrumentality/agency) correlated with favorable voice appraisals and balanced power perceptions between voice and voice hearer. These positive effects seem to be more pronounced in women. The gender of both voice and voice hearer shapes the voice hearing experience in manifold ways. Due to possible favorable effects on clinical outcomes, therapeutic concepts that strengthen instrumental/agentic traits could be a feasible target for psychotherapeutic interventions in voice hearing, especially in women.
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47
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Barrera A, Bajorek T, Dekker R, Hothi G, Lewis A, Pearce S. A Phenomenological Exploration of the Voices Reported by Borderline Personality and Schizophrenia Patients. Psychopathology 2021; 54:159-168. [PMID: 33975316 DOI: 10.1159/000516208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/28/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Over time, there have been different views regarding the verbal auditory hallucinations (VAHs) reported by borderline personality disorder (BPD) and schizophrenia patients. More recently, their similarity has been emphasized, a view that undoubtedly has significant implications in terms of differential diagnosis and management. To explore this important issue, we undertook a detailed phenomenological assessment of persistent VAH reported by BPD and schizophrenia DSM-IV participants. METHODS The Psychotic Symptoms Rating Scale (PSYRATS), the Revised Beliefs About Voices Questionnaire (BAVQ-R), the Multidimensional Scale for Hallucinations (MSH), and a detailed clinical interview were administered to 11 BPD and 10 schizophrenia DSM-IV participants. RESULTS The VAHs of both groups were similar regarding intensity, reported as located inside or outside the head, and frequency in which they were described as a third-person phenomenon. However, the patients' stance towards their VAH was clearly different. Whilst BPD patients identified them in a clear way in terms of gender and age and disliked them, schizophrenia patients identified them more vaguely, reported them both as more disruptive but at the same time engaged with them more positively; schizophrenia patients also integrated their VAH more into delusions. DISCUSSION Whilst reporting similar intensity of their VAH, the 2 groups' stance towards them were strikingly different in that BPD participants regarded them as identifiable and unequivocally unpleasant whilst schizophrenia participants regarded them in a rather vague and ambiguous manner. Methodologically, this preliminary study suggests that in-depth phenomenological assessment can help to elucidate the differential diagnosis of VAH in these, possibly other, clinical groups. Further research is warranted to establish whether these preliminary findings are replicated on a bigger clinical sample.
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Affiliation(s)
- Alvaro Barrera
- Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, United Kingdom
| | - Tomasz Bajorek
- Psychological Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | | | - Gurjiven Hothi
- Central and North West London NHS Foundation Trust, London, United Kingdom
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48
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Mourgues C, Negreira AM, Quagan B, Mercan NE, Niles H, Kafadar E, Bien C, Kamal F, Powers AR. Development of Voluntary Control Over Voice-Hearing Experiences: Evidence From Treatment-Seeking and Non-Treatment-Seeking Voice-Hearers. SCHIZOPHRENIA BULLETIN OPEN 2020; 1:sgaa052. [PMID: 33196043 PMCID: PMC7643545 DOI: 10.1093/schizbullopen/sgaa052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Voluntary control over voice-hearing experiences is one of the most consistent predictors of functioning among voice-hearers. However, control over voice-hearing experiences is likely to be more nuanced and variable than may be appreciated through coarse clinician-rated measures, which provide little information about how control is conceptualized and developed. We aimed to identify key factors in the evolution of control over voice-hearing experiences in treatment-seeking (N = 7) and non-treatment-seeking (N = 8) voice-hearers. Treatment-seeking voice-hearers were drawn from local chapters of the Connecticut Hearing Voices Network, and non-treatment-seeking voice-hearers were recruited from local spiritually oriented organizations. Both groups participated in a clinical assessment, and a semi-structured interview meant to explore the types of control exhibited and how it is fostered. Using Grounded Theory, we identified that participants from both groups exerted direct and indirect control over their voice-hearing experiences. Participants that developed a spiritual explanatory framework were more likely to exert direct control over the voice-hearing experiences than those that developed a pathologizing framework. Importantly, despite clear differences in explanatory framework and distress because of their experiences, both groups underwent similar trajectories to develop control and acceptance over their voice-hearing experiences. Understanding these factors will be critical in transforming control over voice-hearing experiences from a phenomenological observation to an actionable route for clinical intervention.
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Affiliation(s)
- Catalina Mourgues
- Department of Psychiatry and the Connecticut Mental Health Center, Yale University, New Haven CT
| | - Alyson M Negreira
- Department of Psychiatry and the Connecticut Mental Health Center, Yale University, New Haven CT
| | - Brittany Quagan
- Department of Psychiatry and the Connecticut Mental Health Center, Yale University, New Haven CT
| | | | - Halsey Niles
- Department of Psychiatry and the Connecticut Mental Health Center, Yale University, New Haven CT.,Yale University School of Medicine, New Haven, CT
| | | | - Claire Bien
- Department of Psychiatry and the Connecticut Mental Health Center, Yale University, New Haven CT
| | - Faria Kamal
- Department of Psychiatry, Columbia University, New York, NY
| | - Albert R Powers
- Department of Psychiatry and the Connecticut Mental Health Center, Yale University, New Haven CT.,Yale University School of Medicine, New Haven, CT.,Department of Psychology, Yale University, New Haven, CT
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49
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Kusztrits I, Larøi F, Laloyaux J, Marquardt L, Sinkeviciute I, Kjelby E, Johnsen E, Sommer IE, Hugdahl K, Hirnstein M. Mapping psychotic-like experiences: Results from an online survey. Scand J Psychol 2020; 62:237-248. [PMID: 33009660 DOI: 10.1111/sjop.12683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 08/17/2020] [Indexed: 11/26/2022]
Abstract
Suggestions have been made that psychotic-like experiences (PLEs), such as hallucinatory and delusional experiences, exist on a continuum from healthy individuals to patients with a diagnosis of schizophrenia. We used the screening questions of the Questionnaire for Psychotic Experiences (QPE), an interview that captures the presence and phenomenology of various psychotic experiences separately, to assess PLEs in Norway. Based on data from an online survey in a sample of more than 1,400 participants, we demonstrated that the QPE screening questions show satisfactory psychometric properties. Participants with mental disorders reported more frequent lifetime and current hallucinatory experiences than participants without mental disorders. Childhood experiences were rather low and ranged from 0.7% to 5.2%. We further replicated findings that young age, illegal drug use, lower level of education, and having parents with a mental disorder are associated with higher endorsement rates of PLEs. Finally, a binomial regression revealed that the mere presence of PLEs does not discriminate between individuals with and without a mental disorder. Taken together, the findings of the present study support existing models that both hallucinations and delusions exist on a structural and phenomenological continuum. Moreover, we demonstrated that the QPE screening questions can be used by themselves as a complementary tool to the full QPE interview.
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Affiliation(s)
- Isabella Kusztrits
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,NORMENT Norwegian Centre for Mental Disorders Research, University of Bergen and Haukeland University Hospital, Bergen, Norway
| | - Frank Larøi
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,NORMENT Norwegian Centre for Mental Disorders Research, University of Bergen and Haukeland University Hospital, Bergen, Norway.,Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Julien Laloyaux
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,NORMENT Norwegian Centre for Mental Disorders Research, University of Bergen and Haukeland University Hospital, Bergen, Norway.,Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Lynn Marquardt
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,NORMENT Norwegian Centre for Mental Disorders Research, University of Bergen and Haukeland University Hospital, Bergen, Norway
| | - Igne Sinkeviciute
- NORMENT Norwegian Centre for Mental Disorders Research, University of Bergen and Haukeland University Hospital, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Eirik Kjelby
- NORMENT Norwegian Centre for Mental Disorders Research, University of Bergen and Haukeland University Hospital, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Erik Johnsen
- NORMENT Norwegian Centre for Mental Disorders Research, University of Bergen and Haukeland University Hospital, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Iris E Sommer
- Department of Biomedical Sciences, RijksUniversiteit Groningen (RUG), University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Kenneth Hugdahl
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,NORMENT Norwegian Centre for Mental Disorders Research, University of Bergen and Haukeland University Hospital, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Marco Hirnstein
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,NORMENT Norwegian Centre for Mental Disorders Research, University of Bergen and Haukeland University Hospital, Bergen, Norway
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50
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Spencer HM, Dudley R, Freeston MH, Turkington D. What are the essential ingredients of a CBT case conceptualization for voices and delusions in schizophrenia spectrum disorders? A study of expert consensus. Schizophr Res 2020; 224:74-81. [PMID: 33069578 DOI: 10.1016/j.schres.2020.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/26/2020] [Accepted: 09/26/2020] [Indexed: 11/17/2022]
Abstract
Evidence supports the use of cognitive behavioural therapy (CBT) for the treatment of patients with schizophrenia spectrum disorders. A case conceptualization (CC) (or case formulation) is seen as the keystone of CBT in terms of making sense of a patient's difficulties, to guide and inform such treatment. Despite the importance placed on CC there is no known consensus amongst experts as to the essential ingredients involved in this fundamental process. This study used the Delphi method to establish expert consensus for the essential components of a CC when working to treat auditory hallucinations (voices), and persecutory delusions. An international panel of 78 CBT for psychosis (CBTp) experts from 12 different countries participated in the main stage of this study. This 3-stage process involved producing and rating statements that addressed key areas of CC in terms of: presenting issues, predisposing, precipitating, perpetuating and protective factors. One presenting issue and 6 perpetuating factors were endorsed as essential by >80% of the expert panel. The exact same items were endorsed for both voices, and persecutory delusions. The findings are unique in that a large panel of international experts reached consensus that case conceptualizations (CCs) should be parsimonious and focused on the perpetuating (maintaining) factors to facilitate change. Overall, the proposed recommendations should lead to core guidance for the process of developing CCs, and improvements in training for clinicians that conceptualize voices, and persecutory delusions in CBT for schizophrenia spectrum disorders.
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Affiliation(s)
- Helen M Spencer
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom; Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, United Kingdom.
| | - Robert Dudley
- School of Psychology, Newcastle University, Newcastle upon Tyne, United Kingdom; Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, United Kingdom
| | - Mark H Freeston
- School of Psychology, Newcastle University, Newcastle upon Tyne, United Kingdom; Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, United Kingdom
| | - Douglas Turkington
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, United Kingdom
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