What are the effects of group cognitive behaviour therapy for voices? A randomised control trial

Department of Psychology, Institute of Psychiatry, Kings College London, United Kingdom.
Schizophrenia Research (Impact Factor: 4.43). 10/2005; 77(2-3):201-10. DOI: 10.1016/j.schres.2005.03.013
Source: PubMed

ABSTRACT Little evidence exists for the effects of psychological treatment on voices even though it is clear that CBT does affect delusions and symptoms overall. This study tested whether a group based on cognitive behavioural principles could produce beneficial effects on hallucinations.
To test the effectiveness of group CBT on social functioning and severity of hallucinations.
Participants were included if they had a diagnosis of schizophrenia and experienced distressing auditory hallucinations (rated on the PANSS). They were randomly allocated to group CBT (N = 45) or a control group who received treatment as usual (N = 40). The two main outcomes were social functioning as measured by the Social Behaviour Schedule and the severity of hallucinations as measured by the total score on the Hallucinations Scale of PSYRATS. Assessments were carried out at baseline, 10 weeks (post therapy) and 36 weeks (six months following therapy).
Mixed random effects models revealed significant improvement in social functioning (effect size 0.63 six months after the end of therapy). There was no general effect of group CBT on the severity of hallucinations. However, there was a large cluster effect of therapy group on the severity of hallucinations such that they were reduced in some but not all of the therapy groups. Improvement in hallucinations was associated with receiving therapy early in the trial and having very experienced therapists (extensive CBT training which included expert supervision for a series of individual cases for at least a year following initial training).
Group CBT does improve social functioning but unless therapy is provided by experienced CBT therapists hallucinations are not reduced.

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Available from: Til Wykes, Mar 10, 2015
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    • "comparing group CBTp with treatment as usual (Barrowclough et al., 2006; Wykes et al., 2005), group psycho-education (Bechdolf et al., 2004; 2010), social skills training (Lecomte et al., 2008) or enhanced supportive therapy incorporating emotional support and non-symptom related counselling (Penn et al., 2009) with mixed findings. There is some evidence that long term group CBTp can be more effective than individual CBTp if used as an early intervention (Saska, Cohen, Srihari, & Woods, 2009) or for those with less severe symptoms (Lockwood, Page, & Conroy-Hiller, 2004). "
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    ABSTRACT: Individual cognitive behaviour therapy for psychosis (CBTp) is a recommended treatment in the acute phase and beyond. However, less is known about the effectiveness of group CBTp in acute care. This mixed methods study explored the implementation and effectiveness of brief group CBTp with inpatients. This prospective trial compared inpatients who received either a four week group CBTp program or treatment as usual (TAU). Participants (n = 113 at baseline) completed self-report measures of distress, confidence and symptoms of psychosis at baseline, post-intervention and one month follow up. CBTp group participants also completed a brief open-ended satisfaction questionnaire. Using complete case analysis participants who received CBTp showed significantly reduced distress at follow up compared to TAU and significantly increased confidence across the study and follow up period. However, these effects were not demonstrated using a more conservative intention-to-treat analysis. Qualitative analysis of the satisfaction data revealed positive feedback with a number of specific themes. The study suggests that brief group CBTp with inpatients may improve confidence and reduce distress in the longer term. Participants report that the groups are acceptable and helpful. However, given the methodological limitations involved in this ‘real world’ study more robust evidence is needed.
    Behaviour Research and Therapy 12/2014; 65. DOI:10.1016/j.brat.2014.12.008
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    • "aimed at coping behaviour (Cather et al., 2005; Wykes et al., 2005; Penn et al., 2009) or worry (Foster et al., 2010). These studies were used in sensitivity analyses too. "
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    ABSTRACT: There is no meta-analysis of cognitive behavioural therapy for delusions and hallucinations separately. The aim of this meta-analysis is to evaluate the end-of-treatment effects of individually tailored case-formulation cognitive behavioural therapy on delusions and auditory hallucinations using symptom-specific outcome measures. A systematic search of the trial literature was conducted in MEDLINE, PSYCHINFO and EMBASE. Eighteen studies were selected with symptom specific outcome measures. Hedges' g was computed and outcomes were pooled meta-analytically using the random-effects model. Our main analyses were with the selected studies with CBT using individually tailored case-formulation that aimed to reduce hallucinations and delusions. The statistically significant effect-sizes were 0.36 with delusions and 0.44 with hallucinations, which are modest and in line with other recent meta-analyses. Contrasted with active treatment, CBT for delusions lost statistical significance (0.33), but the effect-size for CBT for hallucinations increased (0.49). Blinded studies reduced effect-size in delusions (0.24) and gained some in hallucinations (0.46). There was no heterogeneity in hallucinations and moderate heterogeneity in delusion trials. We conclude that CBT is effective in treating auditory hallucinations. CBT for delusions is also effective, but the results must be interpreted with caution, because of heterogeneity and the non-significant effect-sizes when compared with active treatment.
    Schizophrenia Research 04/2014; DOI:10.1016/j.schres.2014.03.016
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    • "Higher scores indicate stronger negative beliefs. (3) Subjectively Effective Coping Strategies following the process adopted by Wykes et al. (2005). The key score was the total number of at least partly effective coping strategies used that week. "
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    ABSTRACT: Objectives. Hearing voices groups (HVGs) are increasingly common in National Health Services and are often preferred to individual therapy by both service users and providers. Whilst a range of approaches exist, mixed results have been found and only cognitive behaviour therapy (CBT) was supported by well-controlled trials. This study aimed to explore possible predictors and mechanisms of change in a seven-session CBT group for voice hearers. Design. An exploratory case series design was used. Method. Fifteen outpatients with a diagnosis of schizophrenia or schizoaffective disorder completed a HVG and carried out weekly measures of distress, negative beliefs about voices, self-esteem, effective coping strategies, and activity levels. Visual inspection and quantitative rules were used to group participants with similar results and cross-correlations and t tests were used to verify key findings. Results. Several pathways emerged across therapy. Despite measurement frequency, changes on different outcomes tended to occur simultaneously, making conclusions about mechanisms difficult. However, changes in beliefs about voice malevolence and omnipotence correlated most frequently with changes in distress. Visual analysis indicated 53% of participants improved on a measured outcome but satisfaction scores were higher, with 93% feeling the group helped them deal with their problems more effectively. Clients especially valued the chance to meet similar others. Conclusions. The results suggest HVGs are valued by clients, regardless of their background or symptoms. HVGs should emphasize testing negative beliefs about voices and allow space for supportive discussions between clients. Recommendations for future research are discussed, including consideration of benefits not detected by outcome measures. • The evidence for Hearing voices groups (HVGs) is mixed, despite their popularity. There is therefore a need for process research to enhance efficacy. • Within our case series (N= 15) employing weekly measurement, changes in negative beliefs about voices correlated more closely with distress than changes in coping strategies, activity levels, or self-esteem. • Baseline symptom scores could not predict dropouts from therapy, indicating clients should not be excluded based on demographic or symptom scores. • Satisfaction data indicated outcome measures did not capture all the benefits of HVGs and most clients valued normalization more than any change in outcome.
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