RELATE-a randomised controlled feasibility trial of a Relating Therapy module for distressing auditory verbal hallucinations: a study protocol

Introduction Auditory verbal hallucinations (AVHs) are associated with distress and reduced functioning. Research suggests that distress is associated with the voice hearer's responding to AVH in a passive and subordinate manner. A novel approach focuses on relating to AVH and teaches assertive responses to AVH using experiential role-plays. A small pilot study found a large effect of this approach on AVH distress but an independent multicentre study is required to ascertain effectiveness across different settings. We aim to estimate the expected effect for a subsequent trial to demonstrate that adding a module of Relating Therapy (RT) to treatment as usual (TAU) is superior to TAU alone in reducing AVH distress. We also test the feasibility of patient recruitment, therapist training, and therapy monitoring in different psychological and psychiatric outpatient facilities in Germany. Methods and analysis We will recruit 75 patients diagnosed with a schizophrenia spectrum disorder and persistent distressing AVH across four sites. Patients will be randomised to receive either 16 sessions of RT plus TAU or TAU alone within a 5-month period. Randomisation will be stratified by sites. Single-blind assessments will take place at baseline, at 5 months (T1) and at 9 months (T2). The primary outcome is the distress factor score of the AVH subscale of the Psychotic Symptoms Rating Scale at T2 adjusted for the baseline value. Secondary outcomes are change in depressive symptoms, quality of life, time spent in structured activities as well as negative relating to voices and to other people. Ethics and dissemination The trial has received ethical approval from the German Psychological Society Ethics Committee. The trial results will be disseminated through conference presentations, peer-reviewed publications and social media

A Cross-National Investigation of Hallucination-Like Experiences in 10 Countries: The E-CLECTIC Study

Hallucination-like experiences (HLEs) are typically defined as sensory perceptions in the absence of external stimuli. Multidimensional tools, able to assess different facets of HLEs, are helpful for a better characterization of hallucination proneness and to investigate the cross-national variation in the frequencies of HLEs. The current study set out to establish the validity, factor structure, and measurement invariance of the Launay-Slade Hallucinations Scale-Extended (LSHS-E), a tool to assess HLEs. A total of 4419 respondents from 10 countries were enrolled. Network analyses between the LSHS-E and the 3 dimensions of the Community Assessment of Psychic Experiences (CAPE) were performed to assess convergent and divergent validity of the LSHS-E. Confirmatory factor analysis was used to test its measurement invariance. The best fit was a 4-factor model, which proved invariant by country and clinical status, indicating cross-national stability of the hallucination-proneness construct. Among the different components of hallucination-proneness, auditory-visual HLEs had the strongest association with the positive dimension of the CAPE, compared with the depression and negative dimensions. Participants who reported a diagnosis of a mental disorder scored higher on the 4 LSHS-E factors. Small effect size differences by country were found in the scores of the 4 LSHS-E factors even after taking into account the role of socio-demographic and clinical variables. Due to its good psychometric properties, the LSHS-E is a strong candidate tool for large investigations of HLEs

Discontinuation Success Scale (GERMAN)

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Are effort‐based decision‐making tasks worth the effort?—A study on the associations between effort‐based decision‐making tasks and self‐report measures

Abstract Objectives Amotivation is a common symptom in various mental disorders, including psychotic or depressive disorders. Effort‐based decision‐making (EBDM)‐tasks quantifying amotivation at a behavioral level have been on the rise. Task performance has been shown to differentiate patient groups from healthy controls. However, findings on indicators of construct validity, such as the correlations between different tasks and between tasks and self‐reported/observer‐rated amotivation in clinical and healthy samples have been inconclusive. Methods In a representative community sample (N = 90), we tested the construct validity of the Deck Choice Task, the Expenditure for Rewards Task and the Balloon Task. We calculated correlations between the EBDM‐tasks and between the EBDM‐tasks and self‐reported amotivation, apathy, anticipatory pleasure, and BIS/BAS. Results Correlations between tasks were low to moderate (0.198 ≤ r ≤ 0.358), with the Balloon Task showing the largest correlations with the other tasks, but no significant correlations between any EBDM‐task and the self‐report measures. Conclusion Although different EBDM‐tasks are conceptualized to measure the same construct, a large part of what each task measures could not be accounted for by the other tasks. Moreover, the tasks did not appear to substantially capture what was measured in established self‐report instruments for amotivation in our sample, which could be interpreted as questioning the construct validity of EBDM‐tasks

Can Gender Differences in Distress Due to Difficult Voices Be Explained by Differences in Relating?

Background: Research on gender differences has found that women relate to negative voice hearing experiences with more negative emotions and report more distress due to voices, which may be rooted in differences in relating to voices. This study used a robust methodology and a large sample to explore gender differences in relating to voices and voice distress. Methods: Matched samples of male (n = 124) and female (n = 124) voice hearers were drawn from a survey for secondary analysis. Voice severity (e.g., frequency or loudness), voice distress, and different types of dysfunctional (i.e., passive or aggressive) and functional (assertive) relating were measured. Group comparisons, mediation models, and network analyses were calculated. Results: Female voice hearers reported more severe voices, more voice distress, more passive, and less assertive relating. Mediation and network analyses yielded evidence for pathways from gender to voice distress via relating and via differences in voice severity. Conclusion: Gender differences in the emotional impact of voices can be partially explained by relating behavior. Psychological interventions for voice hearing could be optimized by exploring the influence of gender in the emergence of distressing voices. Nevertheless, gender differences need to be treated as one of several different possible mechanisms when working with individual patients