Changes in positive and negative voice content in cognitive‐behavioural therapy for distressing voices

Objective People who experience distressing voices frequently report negative (e.g. abusive or threatening) voice content and this is a key driver of distress. There has also been recognition that positive (e.g. reassuring, or guiding) voice content contributes to better outcomes. Despite this, voice content has been neglected as a standalone outcome in evaluations of psychological therapies for distressing voices. We aimed to examine whether a modular cognitive-behavioural therapy (CBT) intervention for voices led to changes in negative and positive voice content. Design/Methods In a naturalistic, uncontrolled pre- and post- service evaluation study, 32 clients at an outpatient psychology service for distressing voices received eight sessions of CBT for distressing voices and completed self-report measures of negative and positive voice content at pre-, mid- and post- therapy. Results There was no significant change in positive voice content. There was no significant change in negative voice content from pre- to post-therapy; however, there was a significant change in negative voice content between mid and post-treatment in which the cognitive therapy component was delivered. The CBT treatment was also associated with significant changes in routinely reported outcomes of voice-related distress and voice severity. Conclusions The cognitive component of CBT for distressing voices may be associated with changes in negative, but not positive, voice content. There may be benefit to enhancing these effects by developing treatments targeting specific processes involved in negative and positive voice content and further exploring efficacy in well-powered, controlled trials with more comprehensive measures of voice content

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

Determining reliable and clinically significant change is central to evidence‐based practice yet rarely used in routine clinical settings. This paper illustrates these methods in the context of an evaluation of cognitive behaviour therapy for distressing auditory hallucinations (“voices”). We used data from a clinical sample attending Perth Voices Clinic, a transdiagnostic outpatient service for distressing voices, and a previously published reference sample of healthy voice hearers. Our outcomes on the primary measure of voice distress, derived from a previous factor analysis of the Psychotic Symptom Rating Scale‐Auditory Hallucinations subscale, showed that 62.9% of clients were classified as Recovered/Improved, 35.5% were classified as Unchanged, and 0.02% were classified as Deteriorated. Partial support for the validity of these classifications was obtained from the scores on the Depression, Anxiety, Stress Scales (Lovibond & Lovibond, 1995) but not on the Social and Occupational Functional Assessment Scale (Goldman et al., 1992). Clients classified as Recovered showed better emotional functioning on the Depression, Anxiety, Stress Scales compared with those who did not make a clinically significant change in voice distress. A tool is provided to assist practitioners to evaluate whether individual clients have benefited from therapy for distressing voices or not, which can be used to guide future treatment decisions (https://osf.io/gd9e5/)

Multimodal versus unimodal auditory hallucinations in clinical practice: Treatment outcomes following cognitive-behavioural therapy

Letter to the Edito

Loneliness in autism and Its association with anxiety and depression: a systematic review with meta-analyses

Objectives This systematic review aimed to quantify differences in loneliness levels between autistic and neurotypical samples and investigate the association between loneliness and mental health in autistic individuals. Methods Three meta-analyses were conducted. Studies were methodologically appraised using established tools. Results Overall, 39 studies were included. The majority of these achieved moderate methodological quality ratings. The primary meta-analysis (N = 23) found autistic samples reported higher loneliness compared with neurotypical samples (Hedges’ g = .89). The meta-analyses on the associations between loneliness and anxiety (N = 14) and depression (N = 11) in autistic samples found significant pooled correlations (r = .29 and r = .48, respectively). Conclusions This review highlights numerous limitations within current autism and loneliness research. Nevertheless, loneliness in autism merits targeted clinical and research attention

Hallucinations in Healthy Older Adults: An Overview of the Literature and Perspectives for Future Research

Studies suggest a substantial minority of healthy older adults have hallucinatory experiences, in line with existing evidence on hallucinations in other age groups, though it is still unclear if hallucination prevalence increases or declines with age in older cohorts. Stigma attached to both hallucinations and ageing leads to considerable underreporting of these experiences in healthy older adults and may negatively bias how professionals, family members, and the public respond. Why and when hallucinations in healthy older adults remit, persist, or progress to other clinical disorders remains poorly understood. Current evidence points to a range of factors associated with hallucinations in older adults including decline in sensory or cognitive functioning, poor sleep, and psychosocial stressors (e.g., social isolation, loneliness, and bereavement), highlighting the need for accurate assessment and tailored interventions

Changing attitudes towards voice hearers: A literature review

Auditory verbal hallucinations, or voice hearing, is increasingly understood as a common experience. Despite this, voice hearers still experience a great deal of stigma, which can have serious negative impacts on the person’s experience of their voices, and their recovery. Research has demonstrated that healthcare professionals may be a major source of the stigma surrounding voice hearing, with service-level implications for the development and delivery of evidence-based interventions. Therefore, reducing this stigma is a critical intervention target. The purpose of this narrative review is to examine evidence for interventions aimed at reducing stigma towards people who hear voices, in populations of healthcare professionals, students, and the general public. The available evidence supports the use of anti-stigma interventions based around direct contact with voice hearers and education about voice hearing. However, further research is necessary in this area to confirm these findings

Speed of processing and individual differences in IQ in schizophrenia: General or specific cognitive deficits?

INTRODUCTION: The aim of this study was to re-examine the role of cognitive processing speed in the vulnerability to schizophrenia, using an inspection time (IT) task that does not require a speeded manual response. Since IT consistently correlates with intelligence, the relationship between IT and general intelligence was also explored. METHODS: Patients with schizophrenia were compared with unaffected siblings of schizophrenia patients and healthy controls on a visual IT task. Both speed and variability of IT performance were examined. Current intellectual ability (IQ) was estimated with the Shipley Institute of Living Scale (SILS), which yields separate assessments of verbal and abstraction abilities. RESULTS: Schizophrenia patients produced ITs that were significantly slower and more variable than either unaffected siblings or healthy controls. These results are not related to demographic or clinical variables. A significant negative correlation was obtained between IT and IQ; specifically, longer IT values were associated with abstraction scores only. CONCLUSIONS: These findings confirm that basic cognitive processing efficiency is impaired in patients with schizophrenia. In contrast, ITs in unaffected siblings did not differ from healthy controls, in line with their better IQ test scores. Implications for models of general and specific heritable dimensions in schizophrenia are discussed

Multimodal versus unimodal auditory hallucinations in clinical practice: Clinical characteristics and treatment outcomes

Psychological treatments for hallucinations typically target auditory verbal hallucinations (AVH) but neglect the influence of hallucinations in other sensory modalities. This study compared the baseline clinical characteristics and therapeutic outcomes (following brief Coping Strategy Enhancement) of adult clients (N = 100) with multimodal or unimodal (auditory) hallucinations attending an outpatient service for distressing AVH. The results showed that 72.1% of clients reported multimodal hallucinations in the past month. Group comparisons of most baseline clinical characteristics (AVH features, beliefs about AVH, number of traumatic events, personal and social functioning, negative affect) were non-significant. However, in the subgroup (N = 65) reporting ongoing effects of traumatic events, those with multimodal hallucinations reported significantly higher posttraumatic stress symptoms (d = 0.62). Notably, both multimodal and unimodal hallucination groups showed improvement in AVH distress and frequency post-treatment, but group differences in treatment outcomes were not significant. These findings, in a naturalistic service setting, confirm that multimodal hallucinations are common in people seeking help for distressing AVH and may be associated with higher levels of posttraumatic stress symptoms. Importantly, they also suggest that psychological therapy may be suitable and effective for clients experiencing AVH – irrespective of the presence of hallucinations in other sensory modalities