A study exploring people’s experiences of hearing voices over time: what are the different phases of managing voices and how might these phases affect engagement with services?

Hearing voices (also known as auditory verbal hallucinations) can be a distressing experience. Negative beliefs about voices are associated with negative emotional and behavioural consequences. It is important to understand peoples’ experiences with voices and the different stages of managing them. However, there is no conclusive empirically supported theoretical model illustrating the phases that individuals may encounter when coping with their experiences over time. Typically, research has focused upon retrospective accounts of voice hearing. The aim of this dissertation was to develop an empirically supported model of the stages of voice hearing. This was achieved by examining service users’ experiences with voices over time, identifying different phases of managing voices, and exploring how these phases affected therapeutic intervention. Chapter one is an introduction to the research in this area. Chapter two outlines the methodological processes and issues within this programme of research. Chapter three provides a systematic literature review of longitudinal studies examining distressing voices in clinical populations. Chapter four examines time one interviews and discusses the barriers and enablers to the disclosure of voices. Chapter five reports the findings from interviews with clinicians and explores the barriers and enablers to starting and continuing a conversation about voices with service users. Chapter six presents a model developed from an integration and evaluation of existing models in relation to data generated from interviews conducted longitudinally. Chapter seven summarises findings, discusses the theoretical and clinical implications, outlines the limitations of the programme of research and proposes future directions to continue the research

Creating a hierarchy of mental health stigma: testing the effect of psychiatric diagnosis on stigma

Levels of mental health stigma experienced can vary as a function of the presenting mental health problem (e.g. diagnosis and symptoms). However, these studies are limited because they exclusively use pairwise comparisons. A more comprehensive examination of diagnosis-specific stigma is needed. The aim of our study was to determine how levels of mental health stigma vary in relation to a number of psychiatric diagnoses, and identify what attributions predict levels of diagnosis-specific stigma. We conducted an online survey with members of the public. Participants were assessed in terms of how much stigma they had, and their attributions toward, nine different case vignettes, each describing a different mental health diagnosis. We recruited 665 participants. After controlling for social desirability bias and key demographic variables, we found that mental health stigma varied in relation to psychiatric diagnosis. Schizophrenia and antisocial personality disorder were the most stigmatised diagnoses, and depression, generalised anxiety disorder and obsessive-compulsive disorder were the least stigmatised diagnoses. No single attribution predicted stigma across diagnoses, but fear was the most consistent predictor. Assessing mental health stigma as a single concept masks significant between-diagnosis variability. Anti-stigma campaigns are likely to be most successful if they target fearful attributions

“That little doorway where I could suddenly start shouting out”: barriers and enablers to the disclosure of distressing voices

Hearing distressing voices is a key feature of psychosis. The time between voice onset and disclosure may be crucial as voices can grow in complexity. This study investigated barriers and enablers to early voice disclosure. Interviews with 20 voice hearers underwent Thematic Analysis. Beliefs about the effect of disclosure on self and others acted as a barrier and enabler to voices being discussed. Voice hearing awareness should be increased amongst young people, the public and care services. To support earlier disclosure measures need to increase skill amongst those likely to be disclosed to

Care Workers and Managers’ Experiences of Implementing Infection Control Guidance in an Epidemic Context: A Qualitative Study in the South East of England, during the COVID-19 Prevaccination Era

The national response to COVID-19 has had a severe impact on adult social care settings, with high mortality amongst people receiving and providing care in England. Care workers had to rapidly adapt to new infection control measures to protect themselves, their colleagues, and the people receiving care. Infection control in residential and domiciliary care is always complex, but COVID-19 infection control measures impacted exceptionally on care workers’ working and everyday lives. We undertook qualitative interviews with care workers and managers (n = 10) in residential and domiciliary care for older people in the Southeast England during the first wave of the pandemic to understand their experiences, solutions, and concerns to implement guidance in practice. Data were analysed using framework analysis, and the following eight themes were identified: (1) Increasing visibility and support for the sector; (2) the impact of negative messaging about the sector; (3) feelings of isolation; (4) accessibility and usability of guidance; (5) social care staff as agents in producing and sharing good practice; (6) managing expectations and the impact of conflicting messages in the media; (7) improving communication with hospitals; and (8) problems in the early pandemic. The findings reveal widespread concerns for the marginalisation of the sector in the policy response and the inadequacy of infection control guidance. Guidance would benefit from a better understanding of domiciliary and residential care settings. This might involve the following steps: (a) coproduction of guidance with adult social care stakeholders, including those in direct-care roles and (b) a shift away from a clinical model of infection control towards a more flexible approach that attends to the inherent variability of care settings

How can risk of COVID-19 transmission be minimised in domiciliary care for older people: development, parameterisation and initial results of a simple mathematical model

This paper proposes and analyses a stochastic model for the spread of an infectious disease transmitted between clients and care workers in the UK domiciliary (home) care setting. Interactions between clients and care workers are modelled using specially generated networks, with network parameters reflecting realistic patterns of care needs and visit allocation. These networks are then used to simulate and SEIR-type epidemic dynamics with different numbers of infectious and recovery stages. The results indicate that with the same overall capacity provided by care workers, the minimum peak proportion of infection, and the smallest overall size of infection are achieved for the highest proportion of overlap between visit allocation, i.e. when care workers have the highest chances of being allocated a visit to the same client they have visited before. An intuitive explanation of this is that while providing the required care coverage, maximising overlap in visit allocation reduces the possibility of an infectious care worker inadvertently spreading the infection to other clients. The model is generic and can be adapted to any directly transmitted infectious disease, such as, more recently, COVID-19, provided accurate estimates of disease parameters can be obtained from real data

Relating therapy for voices (the R2V study): study protocol for a pilot randomized controlled trial

Background Evidence exists for the effectiveness of cognitive behaviour therapy for psychosis with moderate effect sizes, but the evidence for cognitive behaviour therapy specifically for distressing voices is less convincing. An alternative symptom-based approach may be warranted and a body of literature has explored distressing voices from an interpersonal perspective. This literature has informed the development of relating therapy and findings from a case series suggested that this intervention was acceptable to hearers and therapists. Methods/Design An external pilot randomized controlled trial (RCT) comparing outcomes for 15 patients receiving 16 hours (weekly sessions of one hour) of relating therapy and their usual treatment with 15 patients receiving only their usual treatment. Participants will be assessed using questionnaires at baseline, 16 weeks (post-intervention), and 36 weeks (follow-up). Discussion Expected outcomes will include a refined study protocol and an estimate of the effect size to inform the sample size of a definitive RCT. If evidence from a fully powered RCT suggests that relating therapy is effective, the therapy will extend the range of evidence-based psychological therapies available to people who hear distressing voices

Relating therapy for distressing voices: Who, or what, is changing?

Background: The experience of hearing distressing voices has recently been conceptualised within relational terms, whereby the voice is perceived as a person-like stimulus with whom the hearer has a difficult relationship. Therapeutic approaches are being developed that seek to modify the relating of the hearer towards the voice, and a conversation has begun about what or who may be changing within these therapies. We sought to empirically inform this discussion by exploring the experience of patients who had received Relating Therapy. Methods: A semi-structured change interview was used to explore the experience of nine participants. Interviews were transcribed verbatim and were analysed using thematic analysis. Results: The analysis of data generated three themes–two of which related to aspects of change (in me and in voices), and one which related to a therapy process (role plays). Conclusions: The findings suggested that changes can be evident in both the hearer and the voice, as a consequence of the hearer adopting a different (more assertive) approach to communicating with the voice. Such communication can enable the hearer to perceive themselves as less vulnerable to the communicative intentions of others