Status and Clinical Experiences from the Challenge Trial – A Randomized Controlled Trial Investigating Virtual Reality-based Therapy for Auditory Hallucinations

Background: Auditory verbal hallucinations are a prevalent symptom in schizophrenia and other psychotic disorders, affecting around 70% of patients. A sizable proportion does not achieve adequate treatment response with current interventions, including antipsychotic medication. Virtual reality-based therapy (VRT) shows promise as a new intervention. Methods: The Challenge Trial is a randomized controlled study examining the efficacy of VRT compared to standard treatment for auditory hallucinations in patients with psychotic disorders. In the intervention arm, virtual reality software and voice modulation are used to design a visual representation of the patient's voice (an avatar) and to transform the therapist's voice to sound like the voice the patient hears. The aim is to foster a dialogue for the patient to strengthen their power, practice self-efficacy, and alter their relation to the voice. During therapy, the avatar becomes more compassionate and/or less powerful. Results: Quantitative data are currently unavailable as recruitment is ongoing. Instead, the design and intervention are presented along with recruitment data, retention rates, and case vignettes. Early clinical experiences are promising, with high acceptability and tolerance among patients. The trial has successfully enrolled a diverse patient population, including those with long-standing histories of hospitalization, medication use, and chronic hallucinations. The effectiveness of VRT varies, for example, some patients have reported significant reductions in the frequency of voices and associated distress, whereas others have primarily noted improvements in emotional responses to the voices. Conclusions: Based on the first 2 years of the Challenge Trial, VRT shows considerable promise as a potential treatment for auditory verbal hallucinations

Family Functioning\u27s Relationship with Compliance in Families with a Child Diagnosed with Attention Deficit Hyperactivity Disorder

The number of children with Attention Deficit/Hyperactivity Disorder [ADHD] is significant and growing (Pastor & Reuben, 2008). For example, the United States Census Bureau survey of medical issues reported that 4.5 million children, representing 7.8% of the population in the United States between the ages of 5 to 17, have been diagnosed with ADHD (National Health Interview Survey, 2006). Compliance in families with a child with ADHD has been a topic of research. A number of studies have specifically investigated medication compliance. It is reported that medication non-adherence can range from 20% to 70% (Stine, 1994). It is not only an issue for medication treatment. It is also reported that 51% do not complete behavioral interventions (Corkum, Rimer, & Schachar, 1999). It is hypothesized that compliance with mental health treatment would have a positive impact on the outcome of treatment for ADHD. Thus, improvement of compliance would be a sought after goal, and ways to achieve compliance would be a beneficial area of research. If a relationship between family functioning and compliance can be established, then interventions directed towards improving family functioning could impact treatment compliance. The focus of the current study is to determine whether there is a relationship between family functioning and compliance with treatment for a child with diagnosis of ADHD. The following research questions will be examined: 1. Is there a relationship between family functioning and treatment compliance as perceived by a parent for a family with a child diagnosed with ADHD? 2. Is there a relationship between family functioning and treatment compliance as perceived by a mental health professional for a family with a child diagnosed with ADHD? Participants were a sample of 63 families who have a child in the home with a diagnosis of ADHD. Both a mental health professional that provided services to the family and a parent/guardian evaluated the family\u27s functioning by each completing the Family Assessment Device [FAD] (Ryan, Epstein, Keitner, Miller, & Bishop, 2005) on the family. The mental health professional also completed a treatment compliance inventory, specifically designed for this study. Significance was only found between the FAD subscale of behavior control and the treatment compliance inventory (p \u3c .001) when the mental health professional completed the FAD. Interventions with families in the development of behavior control could have a positive impact on compliance with this sample. One question raised by this study is why was behavior control not significant when the FAD was completed by a parent

Building the evidence base for assessments and treatment planning with adults who have set fires

Adult-perpetrated deliberate firesetting is a prevalent problem with devastating consequences for wider society. Therefore, the accurate assessment and effective treatment of adults who have set fires is of paramount importance. The overall aim of this thesis was to address gaps in the existing literature to enable clinicians to engage in evidence-based assessments and treatment planning when working with adults who have set fires. Study 1 established, meta-analytically, untreated base rates of reoffending to facilitate clinicians' engagement in more defensible decision making when undertaking risk assessments. These base rates highlighted that repeat firesetting is a significant issue, with 1 in 5 individuals with a history of deliberate firesetting setting further fires. This study also found that individuals with a history of firesetting had five times greater odds of setting further fires than individuals with no known history. Together, these findings highlight the need for specialised firesetting assessments and treatments, particularly for adults who have set fires. In order to ensure such treatments are appropriately tailored, Study 2 undertook a theoretically informed approach to the examination of psychological vulnerabilities associated with multiple firesetting. This study highlighted identification with fire, anger-related cognition and arousal, antisocial attitudes, and impulsivity as potential dynamic risk factors, while also highlighting wider offending and a history of setting cell fires as possible risk markers. Studies 3 and 4 explored the potential to use Virtual Reality (VR) in the assessment and treatment of adult-perpetrated deliberate firesetting. Specifically, Study 3 examined clinicians' perceptions of VR use in this context and identified ways in which VR can improve current assessment and treatment protocols, as well as highlighting barriers that would inhibit wider implementation of the technology. Study 4 constituted a pilot study of the viability of using VR for the assessment of inappropriate fire interest with hospitalised adults. Overall, the findings of this thesis aim to enable clinicians to make better informed decisions when working with adults who have set fires and provide direction for further research in this area