Abstract
ObjectiveThere is mounting evidence that traumatic life events play a role in auditory hallucinations (AH). Theory suggests that some AH are decontextualized trauma memory intrusions. Exposure‐based trauma‐focused therapies that target trauma memory intrusions may therefore be a promising new treatment. We aimed to assess the feasibility and acceptability of a standard protocol trauma‐focused imaginal exposure intervention for trauma‐related AH and to provide initial proof of concept regarding potential effects on AH.DesignWe conducted a single‐arm case series of a six session (90 min per session) imaginal exposure intervention for trauma‐related AH with assessments at baseline, post‐therapy, and one‐month follow‐up.ResultsFifteen people were recruited and eligible to start the intervention. Participants reported high levels of satisfaction; however, temporary distress and symptom exacerbation were common and contributed to discontinuation. There was a large reduction in AH severity at one‐month follow‐up (adjusted d = 0.99), but individual response was highly variable. There were also large reductions in post‐traumatic stress disorder symptoms and the intrusiveness of the trauma memory.ConclusionsImaginal exposure for trauma‐related AH is generally acceptable and may have large effects on AH severity for some people. However, temporary distress and symptom exacerbation are common and can lead to discontinuation. Low referral rates and uptake also suggest feasibility issues for standalone imaginal exposure for AH. The intervention may be more feasible and acceptable in the context of a broader trauma‐focused therapy. Well‐powered trials are needed to determine efficacy and factors that impact on acceptability and therapy response.Practitioner points Some AH can be understood as trauma memory intrusions that lack temporal and spatial contextualization and are therefore experienced without autonoetic awareness.Imaginal exposure to trauma memories associated with AH may be an effective intervention for some people.Temporary distress and symptom exacerbation may be common when using standard trauma‐focused imaginal exposure for AH. This can impact on the acceptability of the therapy and should be considered in future development and delivery.
Highlights
Since psychosis is associated with impairments in spatial and temporal integration, it has been postulated that memories of traumatic events are more severely decontextualized in this group, leading to trauma memory intrusions that occur without autonoetic awareness and are experienced as auditory hallucinations (AH) (Steel, Fowler, & Holmes, 2005)
We aimed to provide an initial proof of concept regarding the effects on AH severity, secondary symptoms (PTSD, delusions, depression, and anxiety), and postulated mechanisms of change
Participants were required to (1) be aged 18–75; (2) have current AH that were frequent and persistent; (3) report a history of post-traumatic stress disorder (PTSD) criterion A traumatic events, childhood adversity, or significant bullying; (4) have made some conceptual links between their past adverse experiences and their AH and, for this reason, be motivated to undertake a trauma-focused intervention; and (5) have a sufficient level of English language to participate in study requirements
Summary
There is mounting evidence that traumatic life events play a role in auditory hallucinations (AH). Temporary distress and symptom exacerbation may be common when using standard trauma-focused imaginal exposure for AH This can impact on the acceptability of the therapy and should be considered in future development and delivery. Since psychosis is associated with impairments in spatial and temporal integration, it has been postulated that memories of traumatic events are more severely decontextualized in this group, leading to trauma memory intrusions that occur without autonoetic awareness and are experienced as AH (Steel, Fowler, & Holmes, 2005) These AH are characterized by content that includes direct replays of aspects of traumatic events (Hardy, 2017). Exposure-based trauma-focused therapies have been highlighted as a potent treatment component for treating post-traumatic stress symptoms in psychosis (Hardy & van den Berg, 2017). We aimed to provide an initial proof of concept regarding the effects on AH severity, secondary symptoms (PTSD, delusions, depression, and anxiety), and postulated mechanisms of change (trauma memory intrusions, the nature of the trauma memory, and post-traumatic cognitions)
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