Assessing the clinical significance of treatment outcomes for distressing voices in routine clinical practice

Abstract

Determining reliable and clinically significant change is central to evidence-based practice yet rarely used in routine clinical settings. This paper illustrates these methods in the context of an evaluation of cognitive behaviour therapy for distressing auditory hallucinations ("voices"). We used data from a clinical sample attending Perth Voices Clinic, a transdiagnostic outpatient service for distressing voices, and a previously published reference sample of healthy voice hearers. Our outcomes on the primary measure of voice distress, derived from a previous factor analysis of the Psychotic Symptom Rating Scale-Auditory Hallucinations subscale, showed that 62.9% of clients were classified as Recovered/Improved, 35.5% were classified as Unchanged, and 0.02% were classified as Deteriorated. Partial support for the validity of these classifications was obtained from the scores on the Depression, Anxiety, Stress Scales (Lovibond & Lovibond, 1995) but not on the Social and Occupational Functional Assessment Scale (Goldman et al., 1992). Clients classified as Recovered showed better emotional functioning on the Depression, Anxiety, Stress Scales compared with those who did not make a clinically significant change in voice distress. A tool is provided to assist practitioners to evaluate whether individual clients have benefited from therapy for distressing voices or not, which can be used to guide future treatment decisions (https://osf.io/gd9e5/).

A service evaluation of a group mindfulness-based intervention for distressing voices: how do findings from a randomized controlled trial compare with routine clinical practice?

“…Furthermore, these outcomes can be viewed from varying perspectives, each of which may seem to tell a slightly different story as: the majority of patients reported an improvement on the primary outcome (71%); about half experienced a treatment response in the minimum improvement category (51%); and reliable change was demonstrated by only a minority (29%). These varying perspectives are reflective of the ongoing debate within the field about which outcomes to measure (Thomas et al, 2014) and how they should be measured (Badcock et al, 2020).…”

Distress factors of voice‐hearing in young people and social relating: Exploring a cognitive‐interpersonal voice‐hearing model

“…The subscales used in this study have demonstrated good reliability (intra‐class correlation coefficient > .93 for distress and > .87 for frequency) (Woodward et al, 2014 ), and they have been used in adult (e.g. Badcock et al, 2020 ; Craig et al, 2018 ; du Sert et al, 2018 ; Hayward et al, 2017 , 2018 ; Jongeneel et al, 2018 ; Lincoln et al, 2021 ; Paulik et al, 2019 , 2018 ) and youth research (Cavelti et al, 2019 ). In this study, internal consistency of PSYRATS‐AH subscales was acceptable (α > .66).…”

Enhancing primary care psychology services with assistant psychologists in Ireland: An evaluation of output, throughput and stakeholder satisfaction

“…To understand if the treatments were effective, the sessional score changes were checked to see if they showed improvement over time. In addition, a reliable change index (RCI) was calculated for the SDQi and the BPSES (Badcock et al., 2020) (Evans et al., 1998) to understand the importance of any change. The SDQi, GBOs and the BPSES items were restructured to a vertical format.…”