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Brief Coping Strategy Enhancement for Distressing Voices: an Evaluation in Routine Clinical Practice

Published online by Cambridge University Press:  27 June 2017

Mark Hayward Open the ORCID record for Mark Hayward [Opens in a new window] ,
Rebecca Edgecumbe ,
Anna-Marie Jones ,
Clio Berry  and
Clara Strauss Open the ORCID record for Clara Strauss [Opens in a new window]
Mark Hayward*
Affiliation:
School of Psychology, University of Sussex, Brighton
Rebecca Edgecumbe
Affiliation:
School of Psychology, University of Sussex
Anna-Marie Jones
Affiliation:
Sussex Partnership NHS Foundation Trust
Clio Berry
Affiliation:
Sussex Partnership NHS Foundation Trust
Clara Strauss
Affiliation:
School of Psychology, University of Sussex
*
Correspondence to Mark Hayward, School of Psychology, University of Sussex, Brighton BN1 9RH. E-mail: mih21@sussex.ac.uk
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Abstract

Background: Hearing voices can be a common and distressing experience. Psychological treatment in the form of cognitive behavioural therapy for psychosis (CBTp) is effective, but is rarely available to patients. The barriers to increasing access include a lack of time for clinicians to deliver therapy. Emerging evidence suggests that CBTp delivered in brief forms can be effective and offer one solution to increasing access. Aims: We adapted an existing form of CBTp, coping strategy enhancement (CSE), to focus specifically on distressing voices in a brief format. This intervention was evaluated within an uncontrolled study conducted in routine clinical practice. Method: This was a service evaluation comparing pre–post outcomes in patients who had completed CSE over four sessions within a specialist out-patient service within NHS Mental Health Services. The primary outcome was the distress scale of the Psychotic Symptoms Rating Scale – Auditory Hallucinations (PSYRATS-AH). Results: Data were available from 101 patients who had completed therapy. A reduction approaching clinical importance was found on the PSYRATS distress scale post-therapy when compared with the baseline. Conclusions: The findings from this study suggest that CSE, as a focused and brief form of CBTp, can be effective in the treatment of distressing voices within routine clinical practice. Within the context of the limitations of this study, brief CSE may best be viewed as the beginning of a therapeutic conversation and a low-intensity intervention in a stepped approach to the treatment of distressing voices.

Keywords

voice hearingauditory hallucinationscognitive behaviour therapycopingclinical practice
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 46 , Issue 2 , March 2018 , pp. 226 - 237
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2017 

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References

Altman, D.G. (1991). Practical Statistics for Medical Research. London: Chapman and Hall.Google Scholar
Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W. and Swinson, R. P. (1998). Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychological Assessment, 10, 176–181.CrossRefGoogle Scholar
Bartram, D. J., Sinclair, J. M. and Baldwin, D. S. (2013). Further validation of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) in the UK veterinary profession: Rasch analysis. Quality of Life Research, 22, 379–391.CrossRefGoogle ScholarPubMed
Birchwood, M. and Chadwick, P. (1997). The omnipotence of voices: testing the validity of a cognitive model. Psychological Medicine, 27, 1345–1353.Google Scholar
Birchwood, M., Gilbert, P., Gilbert, J., Trower, P., Meaden, A., Hay, J. et al. (2004). Interpersonal and role-related schema influence the relationship with the dominant ‘voice’ in schizophrenia: a comparison of three models. Psychological Medicine, 34, 1571– 1580.Google Scholar
Birchwood, M., Michail, M., Meaden, A., Tarrier, N., Lewis, S., Wykes, T. et al. (2014). Cognitive behaviour therapy to prevent harmful compliance with command hallucinations (COMMAND): a randomised controlled trial. The Lancet Psychiatry, 1, 23–33.CrossRefGoogle ScholarPubMed
Chadwick, P., Birchwood, M. and Trower, P. (1996). Cognitive Therapy for Delusions, Voices and Paranoia. Chichester: Wiley.Google Scholar
Chadwick, P., Strauss, C., Jones, A. M., Kingdon, D., Ellett, L., Dannahy, L. and Hayward, M. (2016). Group mindfulness-based intervention for distressing voices: a pragmatic randomised controlled trial. Schizophrenia Research, 175, 168–175. doi: https://doi.org/10.1016/j.schres.2016.04.001 Google Scholar
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences, 2nd edition. New York: Psychology Press.Google Scholar
Department of Health (2005). Research Governance Framework for Health and Social Care, 2nd edition. London.Google Scholar
Dunlap, W. P., Cortina, J. M., Vaslow, J. B. and Burke, M. J. (1996). Meta-analysis of experiments with matched groups or repeated measures designs. Psychological Methods, 1, 170–177.CrossRefGoogle Scholar
Eekhout, I., de Vet, H. C. W., Twisk, J. W. R., Brand, J. P. L., de Boer, M. R. and Heymans, M. W. (2013). Missing data in a multi-item instrument were best handled by multiple imputation at the item score level. Journal of Clinical Epidemiology, 67, 335–342.Google Scholar
Fannon, D., Hayward, P., Thompson, N., Green, G., Surguladze, S. and Wykes, T. (2009). The self or the voice: relative contributions of selfesteem and voice appraisals in persistent auditory hallucinations. Schizophrenia Research, 112, 174–180.Google Scholar
Farhall, J., Greenwood, K. M. and Jackson, H. J. (2007). Coping with hallucinated voices in schizophrenia: A review of self-initiated strategies and therapeutic interventions. Clinical Psychology Review, 27, 476–493.CrossRefGoogle ScholarPubMed
Freeman, D., Startup, H., Pugh, K., Mander, H., Wingham, G., Shirvell, K. et al. (2015). Effects of cognitive behaviour therapy for worry on persecutory delusions in patients with psychosis (WIT): a parallel, single-blind, randomised controlled trial with a mediation analysis. The Lancet Psychiatry, 380, 305–313.CrossRefGoogle Scholar
Greenwood, K. E., Sweeney, A., Williams, S., Garety, P., Kuipers, E., Scott, J. and Peters, E. (2010). Choice of outcome in cbt for psychoses (CHOICE): The development of a new service user-led outcome measure of CBT for psychosis. Schizophrenia Bulletin, 36, 126–135. Adaptation for IAPT-SMI, 2012, unpublished.Google Scholar
Haddock, G., Eisner, E., Boone, C., Davies, G., Coogan, C. and Barrowclough, C. (2014). An investigation of the implementation of NICE-recommended CBT interventions for people with schizophrenia. Journal of Mental Health, 23, 162–165.CrossRefGoogle ScholarPubMed
Haddock, G., McCarron, J., Tarrier, N. and Faragher, E. B. (1999). Scales to measure dimensions of hallucinations and delusions: the psychotic symptoms rating scales (PSYRATS). Psychological Medicine, 29, 879–889.Google Scholar
Hayward, M., Jones, A.-M., Bogen-Johnston, L., Thomas, N. and Strauss, C. (2017). Relating therapy for distressing voices: a pilot randomized controlled trial. Schizophrenia Research, 183, 137–142.Google Scholar
Hazell, C. M., Hayward, M., Cavanagh, K. and Strauss, C. (2016). A systematic review and meta-analysis of low intensity CBT for psychosis. Clinical Psychology Review, 45, 183–192. doi: https://doi.org/10.1016/j.cpr.2016.03.004 Google Scholar
Henry, J. D. and Crawford, J. R. (2005). The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. British Journal of Clinical Psychology /British Psychological Society, 44, 227–239.CrossRefGoogle Scholar
Jolley, S., Garety, P., Peters, E., Fornells-Ambrojo, M., Onwumere, J., Harris, V. et al. (2015). Opportunities and challenges in improving access to psychological therapies for people with severe mental illness (IAPT-SMI): evaluating the first operational year of the South London and Maudsley (SLAM) demonstration site for psychosis. Behaviour Research and Therapy, 64, 24–30.CrossRefGoogle ScholarPubMed
Kjelby, E., Sinkeviciute, I., Gjestad, R., Kroken, R. A., Loberg, E. M., Jorgensen, H. A. et al. (2015). Suicidality in schizophrenia spectrum disorders: the relationship to hallucinations and persecutory delusions. European Psychiatry, 30, 830–836.Google Scholar
Kay, S. R., Fiszbein, A. and Opler, L. A. (1987). The positive and negative syndrome scale for schizophrenia. Schizophrenia Bulletin, 13, 261–276.Google Scholar
Kreyenbuhl, J., Buchanan, R. W., Dickerson, F. B. et al. (2010). The schizophrenia patient outcomes research team (PORT): updated treatment recommendations. Schizophrenia Bulletin, 36, 94–103.Google Scholar
Kuipers, E., Onwumere, J. and Peters, E. (2016). Psychological therapies for psychosis: a view from the hills. The Lancet Psychiatry, 3, 9–10.Google Scholar
Leff, J., Williams, G., Huckvale, M. A., Arbuthnot, M. and Leff, A. P. (2013). Computer-assisted therapy for medication-resistant auditory hallucinations: proof-of-concept study. British Journal of Psychiatry, 202, 428–433.Google Scholar
Loue, S. and Sajatovic, M. (2008). Auditory and visual hallucinations in a sample of severely mentally ill Puerto Rican women: an examination of the cultural context. Mental Health, Religion and Culture, 11, 597–608.Google Scholar
Mawson, A., Cohen, K. and Berry, K. (2010). Reviewing evidence for the cognitive model of auditory hallucinations: the relationship between cognitive voice appraisals and distress during psychosis. Clinical Psychology Review, 30, 248–258.CrossRefGoogle ScholarPubMed
Meddings, S. and Perkins, R. (2002). What ‘getting better’ means to staff and users of a rehabilitation service: an exploratory study. Journal of Mental Health, 11, 319–325.Google Scholar
Mehl, S., Werner, D. and Lincoln, T. M. (2015). Does cognitive behavior therapy for psychosis (CBTp) show a sustainable effect on delusions? A meta-analysis. Frontiers in Psychology, 6, 1450.CrossRefGoogle ScholarPubMed
Naeem, F., Khoury, B., Munshi, T., Ayub, M., Lecomte, T., Kingdon, D. and Farooq, S. (2016). Brief cognitive behavioral therapy for schizophrenia: literature review and meta-analysis. International Journal of Cognitive Therapy, 9, 73–86.CrossRefGoogle Scholar
National Collaborating Centre for Mental Health (2014). Psychosis and schizophrenia in adults: treatment and management. NICE, Feb 54 Clinical Guidelines no. 178.Google Scholar
Schizophrenia Commission (2012). The Abandoned Illness: A Report from the Schizophrenia Commission. London: Rethink Mental Illness.Google Scholar
Sommer, I. E. C., Slotema, C. W., Daskalakis, Z. J., Derks, E. M., Blom, J. D. and Van Der Gaag, M. (2012). The treatment of hallucinations in schizophrenia spectrum disorders. Schizophrenia Bulletin, 38, 704–714.Google Scholar
Stewart-Brown, S. (2008). Warwick-Edinburgh Mental Well-being Scale User Guide. Health (San Francisco) (June).Google Scholar
Tarrier, N. (1992). Management and modification of residual psychotic symoptoms. In Birchwood, M. and Tarrier, N., Innovations in the Psychological Managememnt of Schizophrenia. Chichester: Wiley.Google Scholar
Tarrier, N., Beckett, R., Harwood, S., Baker, A., Yusupoff, L. and Ugarteburu, I. (1993). A trial of two cognitive-behavioural methods of treating drug-resistant residual psychotic symptoms in schizophrenic patients: I. Outcome. British Journal of Psychiatry, 162, 524–532.CrossRefGoogle ScholarPubMed
Tarrier, N., T., Harwood, S., Yusopoff, L., Beckett, R. and Baker, A. (1990). Coping strategy enhancement (CSE): a method of treating residual shizophrenic symptoms. Behavioural Psychotherapy, 18, 283–293.CrossRefGoogle Scholar
Tarrier, N., Kinney, C., McCarthy, E., Wittkowski, A., Yusupof, L., Gledhill, A., Morris, J. et al. (2001). Are some types of psychotic symptoms more responsive to cognitive behaviour therapy? Behavioural and Cognitive Psychotherapy, 29, 45–55.Google Scholar
Thomas, N., Hayward, M., Peters, E., Van Der Gaag, M., Bentall, R. P., Jenner, J. et al. (2014). Psychological therapies for auditory hallucinations (voices): current status and key directions for future research. Schizophrenia Bulletin, 40 (suppl. 4).CrossRefGoogle ScholarPubMed
Thomas, P., Mathur, P., Gottesman, I. I., Nagpal, R., Nimgaonkar, V. L. and Deshpande, S. N. (2007). Correlates of hallucinations in schizophrenia: a cross-cultural evaluation. Schizophrenia Research, 92, 41–49.CrossRefGoogle ScholarPubMed
Tsai, Y. F. and Chen, C. Y. (2006). Self-care symptom management strategies for auditory hallucinations among patients with schizophrenia in Taiwan. Applied Nursing Research, 19, 191–196.CrossRefGoogle ScholarPubMed
van der Gaag, M. (2014). The efficacy of CBT for severe mental illness and the challenge of dissemination in routine care. World Psychiatry, 13, 257–258.Google Scholar
van der Gaag, M., Valmaggia, L. R. and Smit, F. (2014). The effects of individually tailored formulation-based cognitive behavioural therapy in auditory hallucinations and delusions: a meta-analysis. Schizophrenia Research, 156, 30–37.CrossRefGoogle ScholarPubMed
van der Gaag, M., Van Oosterhout, B., Daalman, K., Sommer, I. E. and Korrelboom, K. (2012). Initial evaluation of the effects of competitive memory training (COMET) on depression in schizophrenia-spectrum patients with persistent auditory verbal hallucinations: a randomized controlled trial. British Journal of Clinical Psychology, 51, 158–171.Google Scholar
Waller, H., Garety, P. A., Jolley, S., Fornells-Ambrojo, M., Kuipers, E., Onmumere, J. et al. (2013). Low intensity cognitive behavioural therapy for psychosis: a pilot study. Journal of Behaviour Therapy and Experimental Psychiatry, 44, 98–104.Google Scholar
Woodward, T. S., Jung, K., Hwang, H., Yin, J., Taylor, L., Menon, M. et al. (2014). Symptom dimensions of the psychotic symptom rating scales in psychosis: a multisite study. Schizophrenia Bulletin, 40 (suppl. 4), 265–274.Google Scholar
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