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: 3.92). 10/2005; 77(2-3):201-10. DOI: 10.1016/j.schres.2005.03.013
Source: PubMed


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 · 3.85 Impact Factor
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    • "In addition, because this process is highly complex, it requires a high level of skill in CBT. Accordingly, some trials have observed poorer outcomes with less experienced therapists [27,28]. "
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    BMC Psychiatry 07/2014; 14(1):198. DOI:10.1186/1471-244X-14-198 · 2.21 Impact Factor
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    • "This suggests that integrated intervention can produce broad and persisting benefits. On the other hand, randomized trials of group-based CBT for voices have had disappointing posttherapy advantages over control on voice measures, but have found broader benefits such as improvements in social functioning.49,50 "
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