Individual Cognitive Behavioural Therapy of auditory–verbal hallucinations

Ben Smith, Brendan O’Sullivan, Philip Watson, Juliana Onwumere, Paul Bebbington, Philippa Garety, Daniel Freeman, David Fowler and Elizabeth Kuipers

in Hallucinations

Published on behalf of Oxford University Press

Published in print June 2010 | ISBN: 9780199548590
Published online February 2013 | e-ISBN: 9780191754623 | DOI:
Individual Cognitive Behavioural Therapy of auditory–verbal hallucinations

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In this chapter, we have considered individual CBT for hallucinations. We reviewed the theoretical and empirical literature and outlined the treatment strategies used. In particular and using a case example, we have considered the role of illness perceptions in the maintenance and psychological treatment of hallucinations.

The case supports the hypothesis that illness perceptions (as well as other key cognitive appraisals) may provide useful intervention targets for manipulation in CBT for psychosis. If changing illness perceptions can significantly impact on depression and anxiety and greater emotional dysfunction is predictive of symptom severity (e.g., Smith et al., 2006), then manipulating illness perceptions may directly influence illness outcome.

However, at present in the UK, inadequate numbers of trained CBT providers and problems with treatment resources create limitations. CBT is also not effective for all individuals and did not prevent relapse over the next two years in a recent randomized controlled trial (N = 301), although depression improved (Garety et al., 2008). Questions also remain as to whether CBT for schizophrenia is effective cross-culturally (Rathod et al., 2008) and much of the research currently derives from the USA and UK.

An awareness of the role played by illness perceptions and other appraisals within the context of a multi-factorial psychological model is likely to lead to improvements in interventions for those with psychosis and more specifically hallucinations. Future directions for CBT research will need to aim to develop more theoretically focused interventions to determine specific mechanisms mediating change, in order to develop improved treatment.

We conclude that CBT should emphasize that having a diagnosis of schizophrenia does not necessarily equate to a lifetime of uncontrollable symptoms. Steps can be taken to improve coping and reduce the impact of symptoms. Enhancing perceptions of controllability and working with beliefs about the impact of present/future perceived consequences and length of illness are important treatment strategies.

Chapter.  8869 words.  Illustrated.

Subjects: Psychiatry

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