Psychological therapies for auditory hallucinations (voices): current status and key directions for future research.

I. E. Sommer,S. McCarthy-Jones,M. van der Gaag,M. Hayward,E. Peters,J. Jenner,G. Dodgson,L. C. Johns,C. Strauss,F. Varese,R. P. Bentall,J. M. Garcia-Montes,N. Thomas,F. Waters

doi:10.1093/schbul/sbu037

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.

Highlights

The International Consortium for Hallucinations Research (ICHR) was set up to promote international collaborations on key areas of research related to auditory hallucinations.[1,2] This article reports on the findings of a working group reviewing psychological therapies for hallucinations to identify key directions in future research
A broad spectrum of hallucinatory phenomena arise across a range of populations, we have focused on hearing voices because, as well as this being the most frequent hallucinatory phenomenon encountered in psychotic disorders, voices have been the usual focus of therapies for hallucinations described in the literature to date
In 2 trials of people with schizophrenia with hallucinations or delusions, coping strategy enhancement (CSE) resulted in reduced ratings of symptom severity, compared with both treatment as usual (TAU) and supportive counseling.[13,14]

Summary

Introduction

The International Consortium for Hallucinations Research (ICHR) was set up to promote international collaborations on key areas of research related to auditory hallucinations.[1,2] This article reports on the findings of a working group reviewing psychological therapies for hallucinations to identify key directions in future research. Studies adopted behavioral approaches, based upon addressing hypothesized antecedents and reinforcers of voices These studies examined a range of specific interventions such as relaxation training, graded exposure to voice triggers, manipulation of environmental contingencies for behavioral responding to voices, and even aversion therapy.[11] Other studies, spurred by research into coping in psychosis, examined training in specific coping methods, in particular manipulation of sensory input using ear plugs or music on headphones and use of distraction techniques, with some evidence of effectiveness (see review by Farhall et al[12]). Presented for the range of difficulties associated with psychosis, rather than for voices, CBTp broadly involves working at the meaning level: assisting the person to develop an adaptive understanding of their psychotic experiences, combined with targeted reframing of appraisals linked with distress or interference with functioning.[18] The model of Chadwick and Birchwood[19] was influential in the development of a cognitive understanding of voices. This model is supported by consistent findings of relationships between appraisals of voices and indices of distress and responses to voices.[21]

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