Cognitive behavioural therapy for visual hallucinations: an investigation using a single-case experimental design

Abstract

There has been limited application of cognitive behavioural therapy (CBT) to the treatment of distressing visual hallucinations (VH) in people with psychosis. Preliminary research applying interventions to a novel presenting issue are enhanced by utilizing designs that allow strong inferences to be made about the effect of the intervention. Hence, this study aimed to measure change in appraisal, affect, and behaviour as a consequence of CBT VH, to improve understanding of the process of change. A multiple-baseline experimental single-case design methodology was used with five participants who received a CBT VH treatment package. Participants used daily diary measures to record appraisals, affect, and behaviours related to the distressing VH. Standardized measures were completed at each phase change. Four individuals completed therapy. Formal visual analysis of the data supported by statistical analysis indicated significant changes for appraisal and affect, with replication across three participants. Changes in frequency of VH were reported in two cases. Change was not evident on the standardized measures. This study replicates and extends the findings in showing potential value of CBT VH. Further research should consider alternative methods of capturing behavioural change. Attempts should also be made to replicate across therapists and centres.

A comparison of visual hallucinations across disorders

“…Whilst the questions were related to the distress of seeing the vision, clearly, future research with larger groups of participants (including Alzheimer Dementia, non-clinical populations) could consider if multimodality rather than diagnosis is most indicative of distress and conviction. Of course, other factors such as the content, frequency, persistence and appraisals of what it means to see visions (Dudley et al, 2012) may all also play a role in the distress and conviction reported (Thomson et al, 2017).…”

Kognityvinės Elgesio Terapijos Poveikis Pozityviems Šizofrenijos Simptomams Ir Jų Lydimiesiems Reiškiniams

“…Tyrimų, aprašančių KET naudą regos haliucinacijoms, duomenys parodė, kad intervencijos metu dauguma pacientų tapo labiau kritiški savo simptomatikai (t.y. haliucinacijoms), pagerėjo jų afekto rodikliai, sumažėjo nepageidaujamo elgesio, sukelto pozityvių simptomų, apraiškos [7,8]. Analizuoti tyrimai rodo, jog šizofrenijos atveju svarbu ne tik siekti panaikinti simptomą (haliucinacijas), bet ir mokyti pacientą adekvačiai į jį reaguoti.…”

Hallucinations in Older Adults: A Practical Review

“… 82 , 83 Several psychotherapies initially developed for treating people with a primary psychotic disorder and auditory hallucinations (cognitive behavioral therapy, COMET, acceptance, and commitment) are also applied to older persons, 84 , 85 though less is known about the application of cognitive behavioral therapy for distressing visual hallucinations. 86 In some cases, adjustments need to be made when the cognitive resources of patients are limited. The essence of such therapies is that the patient learns that hallucinations are not a real-life threat, may have personal significance or meaning, or can safely be ignored.…”