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

Background: The 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. Methods: This 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. Results: Nine 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. Conclusion: There 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

A randomised controlled pilot study of Experience Focused Counselling with voice hearers

Background: There is a need for improved psychosocial interventions for distressed voice hearers. Aims: To evaluate a novel approach to hearing voices: Experience Focused Counselling (EFC) aka Making Sense of Voices. Study design and methods: Twelve voice hearers were randomly assigned to a 44-week EFC or Treatment As Usual intervention as part of a pilot study design. Results: At the end of intervention, EFC showed clinically large treatment effect improvements on the Brief Psychiatric Rating Scale – Expanded Version psychotic symptoms (Cohen’s d=1.6) and overall psychopathology domains (d=1.3), and the Psychotic Symptom Rating Scales voices (d=1) and delusions (aka nonshared reality) (d=1) scales. EFC voice hearers also felt more able to do first trauma disclosures (n=4) than TAU group voice hearer (n=1). Discussion: EFC improvements may have been related to the focus on reducing voices-related distress. EFC holds some promise as a safe and effective intervention for voice hearers, with possible improvements in general psychopathology, psychosis, voices and non-shared reality (aka delusions)-related distress. This will need replicating in more powerful studies

Making sense of voices: a case series

The current evidence-base for the psychological treatment of distressing voices indicates the need for further clinical development. The Maastricht approach (also known as Making Sense of Voices) is popular within sections of the Hearing Voices Movement, but its clinical effectiveness has not been systematically evaluated. The aim of the approach is to develop a better understanding of the role of the voice, in part through opening a dialogue between the voice hearer and the voice. The current study was a (N=15) case series adopting a concurrent multiple baseline design. The Maastricht approach was offered for up to 9-months. The main outcome, weekly voice-related distress ratings, was not statistically significant during intervention or follow-up, although the effect size was in the moderate range. The PSYRATS Hallucination scale was associated with a large effect size both at the end of treatment, and after a 3-month follow-up period, although again the effect did not reach statistical significance. The results suggest further evaluation of the approach is warranted. However, given the large variance in individual participant outcome, it may be that a better understanding of response profiles is required before conducting a definitive randomised controlled trial

Voice hearers’ experiences of the Making Sense of Voices in an NHS setting

The Making Sense of Voices (MsV) approach (Romme & Escher, 2000) has become established within large sections of the voice hearing community, as well as being adopted by some professional mental health workers. However, there has been limited research to assess this intervention. A recent case series using the MsV approach (Steel et al., 2019) reported promising results across a number of standardised outcome measures. The current study reports on the voice hearers’ experience of having received the MsV intervention, through the use of ‘exit interviews’ conducted as part of the case series. Individual participants’ experiences indicated a range of reactions to the intervention. Positive outcomes appeared to relate to a better understanding of voice hearing experiences and a greater sense of control over voices. Not all participants reported a positive experience of communicating with their voices. Outcomes are discussed within the context of potential common and distinct ‘ingredients’ of the MsV approach, compared to other approaches to working with distressing voices

Pilotstudie zu Erfahrungsfokussierter Beratung durch Pflegende bei Menschen, die Stimmen hören

Hintergrund: Stimmenhören wie auch die Behandlung und Unterstützung von Menschen, die unter Stimmenhören leiden, werden in der Psychiatrie unterschiedlich definiert. Entgegen dem medizinischen Ansatz, Stimmen als Symptome einer Erkrankung zu definieren und zu behandeln, setzt die mit Stimmenhörenden entwickelte EFC-Beratung auf Akzeptanz und einen konstruktiven Umgang mit den Stimmen. Zur Verbreitung und Anwendung von alternativen therapeutischen Ansätzen in der Praxis, sind psychiatrische Pflegefachpersonen mit ihrem Alltagsbezug prädestiniert. Ziel: Das Ziel war die Überprüfung der Umsetzung des Studienplans als Teil einer Pilotstudie bezüglich dessen Eignung für eine größere Studie. Methode: Die multizentrische Pilotstudie hatte ein einfach verblindetes, randomisiertes, kontrolliertes Design. Die Intervention bestand aus der EFC-Beratung durch Pflegefachpersonen. Die Eignung des Studienplans wurde bezüglich Rekrutierung, Belastung der Studienteilnehmenden, Eignung der Assessmentinstrumente, Anwendung der EFC-Beratung und des Einsatzes von Study-Nurses evaluiert. Resultate: In den beiden Studienzentren konnten wie geplant innerhalb von 15 Monaten 21 Teilnehmende in die Studie eingeschlossen werden. Die Teilnehmenden bewerteten die Studie insgesamt als wenig belastend und die Intervention als hilfreich. Die Anwendung der EFC-Beratung durch die Pflegenden und der Einsatz von Study-Nurses wurde als gut respektive zielführend eingeschätzt. Diskussion: Die Evaluation des Studienplans zeigt, dass sich dieser für die Durchführung einer größeren Studie mit kleineren Anpassungen am Protokoll eignet.Background: Hearing voices and the treatment and support of people who hear voices and are distressed by the experience are defined differently in psychiatry. In contrast to the medical approach to define and treat voices as symptoms of a disease, the EFC counselling approach developed with voice-hearers focuses on non-pathologizing acceptance and a constructive relationship to voices. Mental health nurses with their focus on everyday life are predestined for the disseminationand application of alternative therapeutic approaches in practice. Aim: The aim was to evaluate the study protocol as part of a pilot study regarding its suitability for a larger trial. Method: The multi centre pilot study had a single-blind randomised controlled design. The intervention consisted of EFC counselling by nurses with people who hear voices. The control group received Treatment As Usual (TAU). The suitability of the study design was evaluated in terms of recruitment, burden on study participants, suitability of assessment tools, the application of EFC counselling and the use of study nurses. Results: As planned 21 participants could be included in the study within fifteen months across the two study sites. Overall, the participants rated the study as not very burdensome and the intervention as helpful. The application of EFC by the nurses as well as the use of study nurses was assessed as good and suitable respectively. Discussion: The evaluation of the study protocol shows that with minor adjustments it is suitable for conducting a larger study

Leitfaden für entlassene Strafgefangene

Der Druck nimmt zu. Je weiter unten in der gesellschaftlichen Hierarchie Menschen nach Alternativen suchen, um ihrem scheinbar vorgezeichneten Leben eine andere Wendung zu geben, desto weniger werden diese Versuche honoriert. Das Scheitern ist die Regel, der Erfolg ist die Ausnahme. Daran wird diese kleine Schrift nichts Grundlegendes ändern, einigen wird es ein Wegweiser sein. Studentinnen und Studenten der Sozialen Arbeit an der Evangelischen Fachhochschule Hannover haben mit uns diesen Leitfaden erstellt

Making Sense of Voices: a case series

The current evidence-base for the psychological treatment of distressing voices indicates the need for further clinical development. The Maastricht approach (also known as Making Sense of Voices) is popular within sections of the Hearing Voices Movement, but its clinical effectiveness has not been systematically evaluated. The aim of the approach is to develop a better understanding of the role of the voice, in part through opening a dialogue between the voice hearer and the voice. The current study was a (N = 15) case series adopting a concurrent multiple baseline design. The Maastricht approach was offered for up to 9-months. The main outcome, weekly voice-related distress ratings, was not statistically significant during intervention or follow-up, although the effect size was in the moderate range. The PSYRATS Hallucination scale was associated with a large effect size both at the end of treatment, and after a 3-month follow-up period, although again the effect did not reach statistical significance. The results suggest further evaluation of the approach is warranted. However, given the large variance in individual participant outcome, it may be that a better understanding of response profiles is required before conducting a definitive randomised controlled trial