Barriers to disseminating brief CBT for voices from a lived experience and clinician perspective

Abstract

Access to psychological therapies continues to be poor for people experiencing psychosis. To address this problem, researchers are developing brief interventions that address the specific symptoms associated with psychosis, i.e., hearing voices. As part of the development work for a brief Cognitive Behaviour Therapy (CBT) intervention for voices we collected qualitative data from people who hear voices (study 1) and clinicians (study 2) on the potential barriers and facilitators to implementation and engagement. Thematic analysis of the responses from both groups revealed a number of anticipated barriers to implementation and engagement. Both groups believed the presenting problem (voices and psychosis symptoms) may impede engagement. Furthermore clinicians identified a lack of resources to be a barrier to implementation. The only facilitator to engagement was reported by people who hear voices who believed a compassionate, experienced and trustworthy therapist would promote engagement. The results are discussed in relation to how these barriers could be addressed in the context of a brief intervention using CBT techniques.

Exploring the implementation of cognitive behaviour therapy for psychosis using the Normalization Process Theory framework

“…Overall, participants referred to the lack of provision of CBTp in their teams, which confirms reports from a recent systematic review regarding the low rates of CBTp implementation (Ince et al ., ). Similar to previous studies (Hazell, Strauss, Cavanagh, & Hayward, ; Prytys et al ., ), our findings indicate the difficulties that clinicians face when implementing CBTp, which include the severity of symptoms and reported lack of insight of people with psychosis. In addition, challenges with consistent attendance increased the pessimistic attitudes of professionals regarding the feasibility of recovery and reinforced the lack of implementation.…”

“…According to Hazell, Strauss, Cavanagh, et al . (), professionals’ lack of belief in the efficacy of CBTp reinforces commissioners’ lack of investment in CBTp. Similarly, the lack of Coherence in this study might have reinforced the service level barriers which reflected the lack of Collective Action .…”

Patient experience of Guided self-help CBT intervention for VoicEs (GiVE) delivered within a pilot randomized controlled trial

“…During the development of GiVE we found that mental health clinicians were concerned that patients lacked sufficient motivation to engage in self-help (Hazell et al, 2017b). However, the findings from this study offer a different perspective and suggest that people distressed by hearing voices can engage with self-help materials when guidance is offered.…”

Understanding the Barriers to Accessing Symptom-Specific Cognitive Behavior Therapy (CBT) for Distressing Voices: Reflecting on and Extending the Lessons Learnt From the CBT for Psychosis Literature

“…Furthermore, the voice content itself can act to prevent disclosure (i.e., voices telling the patient not to say anything) ( Beavan and Read, 2010 ). Most often, people do not disclose their voice hearing experiences because of concerns about stigmatizing responses from family, friends, and the wider society ( Beavan et al, 2011 ; Mawson et al, 2011 ; Hazell et al, 2017b ; Bogen-Johnston et al, 2017 ). Even within mental health services, patients are concerned about the potential for stigma from clinicians ( Beavan et al, 2011 ), and the fear of stigma is likely to be reinforced by clinicians who feel it is inappropriate to encourage and initiate conversations about hearing voices ( Coffey and Hewitt, 2008 ).…”