The meaning of voices in understanding and treating psychosis: Moving towards intervention informed by collaborative formulation

Lonergan, Aoife

doi:10.5964/ejop.v13i2.1199

Cited by 11 publications

(10 citation statements)

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“…Much of this was attributed to lack of specific training. In theory, evidence‐based practice should be at the basis of the effectiveness of interventions (Lonergan, 2017; Schultz & Videbeck, 2009). Yet this group of nurses were not fully aware of evidence‐based practice when it came to interventions for hearing voices.…”

Section: Discussionmentioning

confidence: 99%

Help, I can’t help: A qualitative study of psychiatric nurse’s perspectives on their care for people who hear voices

McCluskey

Vries

2020

Psychiatric Ment Health Nurs

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Accessible Summary What is known about the subject? There are no studies on the perceptions of psychiatric nurses on interventions they provided to people hearing voices while in an acute psychiatric unit in Ireland. There are three studies focussed on psychiatric nurses’ experiences of caring for people that hear voices, two based in England and one based in Australia. Only two of these studies is focussed on nurses working in an acute psychiatric unit. What is this paper adds to existing knowledge? This study used semi‐structured interviews to explore perceptions of psychiatric nurses in the Republic of Ireland on interventions they provided people hearing voices while in an acute psychiatric unit. What are the implications for practice? Further quantitative and qualitative research into the nursing practice for people experiencing auditory hallucinations, in both in‐patient and community settings. Follow up supports and supervision after the completion training programmes should be implemented, to ensure the transition of skills and knowledge to the clinical environment. Further investigation into whether or not psychiatric nurses are well prepared for the developments outlined in national polices. Abstract Aims and ObjectivesTo explore the perspectives and experiences of Irish psychiatric nurses working in acute care in regard to their role in addressing hearing voices in the people in their care, with a view to gain insight in the nurses’ personal experiences, interventions they provide, attitudes, knowledge, facilitating factors and challenges. BackgroundTreatment of auditory hallucinations often takes place in acute psychiatric care. Traditionally treatment was focused on medication, but this is no longer the sole approach, with psychosocial interventions gaining ground. Psychiatric nurses have the potential to provide these interventions. As part of the changing emphasis of mental health care in Ireland towards more responsibilities for psychiatric nurses, there is a need to establish whether psychiatric nurses are prepared to take up these added responsibilities. DesignA qualitative study, comprising of semi‐structured interviews (n = 16). ResultsFour themes emerged through thematic analysis. These included (a) the importance of therapeutic relationships; (b) reservations about the emphasis on medication; (c) limitations to interventions; and (d) the lack of focus/structure of interventions. ConclusionsThe use of systematic psychosocial interventions for people who hear voices is not well supported in the acute psychiatric settings the psychiatric nurses in the study worked in.

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Section: Discussionmentioning

confidence: 99%

Help, I can’t help: A qualitative study of psychiatric nurse’s perspectives on their care for people who hear voices

McCluskey

Vries

2020

Psychiatric Ment Health Nurs

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“…Hence, it is widely accepted the importance of facilitating the re-emergence of internal dialogue through external dialogue. Psychotherapy should assist people with schizophrenia to develop a narrative that allows for recovery by creating a context for increasing self-awareness and agency (Lonergan, 2017).…”

Section: Discussionmentioning

confidence: 99%

Exploring a dialogic approach in tackling psychotic diseases: A systematic review

2022

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Psychosis is a severe mental disorder traditionally treated from a purely biological approach, which often has led to a dehumanisation in psychiatric hospitals. To counteract this trend and aiming at tackling the disease with a more human approach, psychosocial interventions have increased. In this vein, interventions based on a dialogic approach, with specific features such as egalitarian dialogue, foster psychological and social transformations in different contexts. This review aims to analyse the clinical and social effects of psychological interventions based on these principles when treating patients with psychosis. A systematic review has been carried out, following PRISMA recommendations, in the Web of Science, Scopus and PsycInfo databases. After applying the inclusion criteria, thirteen empirical studies were selected and analysed, including a quality assessment. These studies show that when introducing a dialogic approach in treating psychosis, positive clinical and relational outcomes are obtained. Likewise, patients value positively these collaborative environments, where they feel listened and understood. Whereas dialogism emerges as a tool with potential benefits to tackle psychosis, more studies are needed to clearer determine the influence of specific dialogic features on improving psychotic patients’ mental health. La psicosis es un trastorno mental grave que tradicionalmente se ha tratado desde un enfoque puramente biológico, lo que a menudo ha conllevado una deshumanización en los hospitales psiquiátricos. Con el fin de contrarrestar esta tendencia y con el objetivo de abordar la enfermedad desde enfoque más humano, las intervenciones psicosociales han aumentado. En esta línea, las intervenciones basadas en un enfoque dialógico, con características específicas como el diálogo igualitario, fomentan transformaciones psicológicas y sociales en diferentes contextos. Esta revisión pretende analizar el impacto clínico y social de las intervenciones psicológicas basadas en principios dialógicos en pacientes con psicosis. Se ha realizado una revisión sistemática, siguiendo las recomendaciones PRISMA, en las bases de datos Web of Science, Scopus y PsycInfo. Tras aplicar los criterios de inclusión, se seleccionaron y analizaron trece estudios empíricos, además, se ha incluido una evaluación de la calidad de dichos estudios. Estos estudios muestran que, al incorporar un enfoque dialógico en el tratamiento de la psicosis, se obtienen resultados clínicos y relacionales positivos. De la misma manera, los pacientes valoran positivamente estos entornos de colaboración, donde se sienten escuchados y comprendidos. Aunque el dialogismo emerge como una herramienta eficaz para abordar la psicosis, se necesitan más estudios para determinar con mayor claridad la influencia de características dialógicas específicas en la salud mental de los pacientes.

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“…These third wave developments included ACT, mindfulness based approaches as well as AVATAR and Relating Therapy may be considered more in line with calls for “alternative” approaches to therapy and support for people who hear voices and are distressed by the experience. This is because they appear to be more open to considering the subjective views and explanatory models of voice-hearers ( 50 ), as well as the relationship of individuals to themselves, to the voices and to people in the social environment ( 51 ).…”

Section: Discussionmentioning

confidence: 99%

Talk-based approaches to support people who are distressed by their experience of hearing voices: A scoping review

Burr

Schnackenberg²,

Weidner³

2022

Front. Psychiatry

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BackgroundThe positive effects of both antipsychotic medication and cognitive behavioral therapy in psychosis (CBTp) for people who are distressed by their experience of hearing voices remain limited. As a result, there has been a recent surge in talk-based individual approaches. Many of these continue not to be very well known nor implemented in practice. Some of the approaches may focus more on understanding and dealing constructively with voices, an element that has been identified as potentially helpful by voice hearers. Existing barriers to a wider implementation include both the widespread pathologization of hearing voices and a lack of mental health professionals who have been trained and trusted to carry out these new interventions.MethodsThis scoping review aimed to identify and describe a current synthesis of talk-based individual approaches for people who hear voices, including studies independently of method of study or approach, diagnosis of voice hearers nor of the professional background of interventionists.ResultsNine different talk-based approaches were identified. These included: (1) Cognitive Behavioral Therapy for Psychosis (CBTp); (2) AVATAR therapy; (3) Making Sense of Voices (MsV) aka Experience Focused Counselling (EFC); (4) Relating Therapy; (5) Acceptance and Commitment Therapy; (6) Smartphone-based Coping-focused Intervention; (7) Prolonged and Virtual Reality Exposure Therapy; (8) Eye Movement Desensitization and Reprocessing, and (9) Individual Mindfulness-based Program for Voice Hearing. The different approaches differed greatly in relation to the number of sessions, length of time offered and the scientific evidence on efficacy. Psychologists represented the main professional group of interventionists. CBTp and the MsV/EFC approach also included health professionals, like nurses, as implementers. Most of the approaches showed positive outcomes in relation to voice related distress levels. None identified overall or voice specific deteriorations.ConclusionThere appears to be a strong case for the implementation of a broader heterogeneity of approaches in practice. This would also be in line with recommendations for recovery focused services and requirements of voice hearers. A greater emphasis on whole systems implementation and thus the involvement of frontline staff, like nurses, in the delivery of these approaches would likely reduce the research-practice implementation gap.

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The meaning of voices in understanding and treating psychosis: Moving towards intervention informed by collaborative formulation

Cited by 11 publications

References 70 publications

Help, I can’t help: A qualitative study of psychiatric nurse’s perspectives on their care for people who hear voices

Help, I can’t help: A qualitative study of psychiatric nurse’s perspectives on their care for people who hear voices

Exploring a dialogic approach in tackling psychotic diseases: A systematic review

Talk-based approaches to support people who are distressed by their experience of hearing voices: A scoping review

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