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.

Download full-text


Available from: Til Wykes, Mar 10, 2015
  • Source
    • "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). "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Dec 2014 · Behaviour Research and Therapy
  • Source
    • "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]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Cognitive behavior therapy for psychosis has been a prominent intervention in the psychological treatment of psychosis. It is, however, a challenging therapy to deliver and, in the context of increasingly rigorous trials, recent reviews have tempered initial enthusiasm about its effectiveness in improving clinical outcomes. Acceptance and commitment therapy shows promise as a briefer, more easily implemented therapy but has not yet been rigorously evaluated in the context of psychosis. The purpose of this trial is to evaluate whether Acceptance and Commitment Therapy could reduce the distress and disability associated with psychotic symptoms in a sample of community-residing patients with chronic medication-resistant symptoms. Methods/Design This is a single (rater)-blind multi-centre randomised controlled trial comparing Acceptance and Commitment Therapy with an active comparison condition, Befriending. Eligible participants have current residual hallucinations or delusions with associated distress or disability which have been present continuously over the past six months despite therapeutic doses of antipsychotic medication. Following baseline assessment, participants are randomly allocated to treatment condition with blinded, post-treatment assessments conducted at the end of treatment and at 6 months follow-up. The primary outcome is overall mental state as measured using the Positive and Negative Syndrome Scale. Secondary outcomes include preoccupation, conviction, distress and disruption to life associated with symptoms as measured by the Psychotic Symptom Rating Scales, as well as social functioning and service utilisation. The main analyses will be by intention-to-treat using mixed-model repeated measures with non-parametric methods employed if required. The model of change underpinning ACT will be tested using mediation analyses. Discussion This protocol describes the first randomised controlled trial of Acceptance and commitment therapy in chronic medication-resistant psychosis with an active comparison condition. The rigor of the design will provide an important test of its action and efficacy in this population. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12608000210370. Date registered: 18 April 2008
    Full-text · Article · Jul 2014 · BMC Psychiatry
  • Source
    • "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 "
    [Show abstract] [Hide abstract]
    ABSTRACT: This report from the International Consortium on Hallucinations Research considers the current status and future directions in research on psychological therapies targeting auditory hallucinations (hearing voices). Therapy approaches have evolved from behavioral and coping-focused interventions, through formulation-driven interventions using methods from cognitive therapy, to a number of contemporary developments. Recent developments include the application of acceptance- and mindfulness-based approaches, and consolidation of methods for working with connections between voices and views of self, others, relationships and personal history. In this article, we discuss the development of therapies for voices and review the empirical findings. This review shows that psychological therapies are broadly effective for people with positive symptoms, but that more research is required to understand the specific application of therapies to voices. Six key research directions are identified: (1) moving beyond the focus on overall efficacy to understand specific therapeutic processes targeting voices, (2) better targeting psychological processes associated with voices such as trauma, cognitive mechanisms, and personal recovery, (3) more focused measurement of the intended outcomes of therapy, (4) understanding individual differences among voice hearers, (5) extending beyond a focus on voices and schizophrenia into other populations and sensory modalities, and (6) shaping interventions for service implementation.
    Full-text · Article · Jun 2014 · Schizophrenia Bulletin
Show more