Brief coping strategy enhancement for distressing voices: Predictors of engagement and outcome in routine clinical practice

Abstract

Cognitive behaviour therapy is recommended internationally as a treatment for psychosis (targeting symptoms such as auditory hallucinations, or "voices"). Yet mental health services are commonly unable to offer such resource-intensive psychological interventions. Brief, symptom-specific and less resource-intensive therapies are being developed as one initiative to increase access. However, as access increases, so might the risk of offering therapy to clients who are not optimally disposed to engage with and benefit from therapy. Thus, it is important to identify who is most/least likely to engage with and benefit from therapy, and when. In the current study, 225 clients were assessed for suitability for a brief, 4-session, manualized, cognitive behaviour therapy-based intervention for voices (named coping strategy enhancement therapy) and 144 commenced therapy, at a transdiagnostic voices clinic based in Sussex, UK. This article reports on the value of depression, anxiety, stress, insight into the origin of voices, length of voice hearing, and demographics in the prediction of engagement and outcomes. The study found that higher levels of baseline depression, anxiety, and stress were significantly associated with poorer outcomes, especially if clients also had high levels of voice-related distress. The engagement analyses showed that levels of voice-related distress at baseline predicted dropout. These findings highlight the importance of assessing negative affect and voice-related distress prior to commencing therapy for distressing voices, to help determine if the client is suitable or ready for brief-coping strategy enhancement.

Evaluating the “C” and “B” in brief cognitive behaviour therapy for distressing voices in routine clinical practice in an uncontrolled study

“…The current study provides initial evidence that individually tailored yet manualized CBT can effectively treat distressing voice‐hearing experiences occurring across diagnoses within routine clinical practice. With regards to the first question, we replicated the previous finding from the Sussex Voices Clinic (Hayward, Edgecumbe, et al, ; Paulik et al, ) that brief CSE (the B in CBT) leads to significant yet modest improvements in voice‐related distress, with just under half the sample (41.9%) reporting clinically meaningful improvements. The effect sizes reported in the current study were larger than those reported by Hayward et al (2017).…”

“…The demographic and clinical characteristics of the 62 clients included in this study are reported in Table . Client characteristics of the study sample are comparable with other studies of CBT in similar voices clinics (Paulik et al, ; Thomas, Rossell, Farhall, Shawyer, & Castle, ).…”

“…The therapy is manualized and structured, making it easy to train mental health clinicians in its delivery. CSE has been found to be acceptable to voice‐hearing clients, and an evaluation of its effectiveness in routine clinical practice revealed small–moderate pre‐ and post‐effect sizes (Hayward, Edgecumbe, Jones, Berry, & Strauss, ; Paulik, Jones, & Hayward, ). However, CSE in this brief form may not yield clinically meaningful and sustainable outcomes—perhaps being just one step in an individual's recovery journey—and could benefit from being offered as part of a therapy pathway in combination with other brief interventions.…”

Client experiences of blending a coping-focused therapy for auditory verbal hallucinations with smartphone-based ecological momentary assessment and intervention

“…Two trials of CSE with people diagnosed with schizophrenia found reduced symptom severity compared with both treatment-as-usual and supportive counselling (Tarrier et al, 1993, Tarrier et al, 1998). A brief four-session format specifically targeting voices appears feasible, and has been associated with reduced hallucination-related distress post-treatment (Hayward et al, 2018; Paulik et al, 2018).…”

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

“…Those who seek help for hallucinations often choose to reduce the level of distress elicited by these perceptions as their main goal for recovery (Greenwood et al, 2010), rather than to eliminate the experience altogether. Drawing on this evidence, there has been considerable investment in developing symptom-focused psychological services ("voices clinics"; Paulik, Thomas, Glasshouse, & Hayward, 2019) and treatments selectively targeting distressing hallucinations (e.g., Fielding-Smith et al, 2015;Hayward, Edgecumbe, Jones, Berry, & Strauss, Hazell, Hayward, Cavanagh, Jones, & Strauss, 2018;Louise, Rossell, & Thomas, 2019;Paulik, Jones, & Hayward, 2018). Furthermore, evidence from self-help groups and cognitive behaviour therapy for psychosis indicates that as distress from hallucinations begins to decline, clients often report that they are feeling better in daily life (Lincoln, Jung, Wiesjahn, & Schlier, 2016;Longden, Read, & Dillon, 2018), which suggests that treatment for hearing voices may have a broader benefit to emotional functioning.…”