Imagery rescripting for the treatment of trauma in voice hearers: a case series

Background: High rates of trauma and post-traumatic stress disorder (PTSD) are reported in people who hear voices (auditory hallucinations). A recent metanalysis of trauma interventions in psychosis showed only small improvements in PSTD symptoms and voices. Imagery Rescripting (ImRs) may be a therapy that is more effective in this population because it generalizes over memories, which is ideal in this population with typically repeated traumas. The primary aims of this study were to investigate whether ImR reduces (1) PTSD symptoms and (2) voice frequency and distress in voice hearers. Methods: A single arm open trial study, case-series design. Twelve voice hearers with previous traumas that were thematically related to their voices participated. Brief weekly assessments (administered sessions 1-8, post-intervention, and 3-month follow-up) and longer measures (administered pre-, mid-, and post-intervention) were administered. Mixed regression analysis was used to analyze the results. Results: There was one treatment dropout. Results of the weekly measure showed significant linear reductions over time in all three primary variables - Voice Distress, Voice Frequency, and Trauma Intrusions - all with large effect sizes. These effects were maintained (and continued to improve for Trauma Intrusions) at 3-month follow-up. On the full assessment tools, all measures showed improvement over time, with five outcomes showing significant time effects: trauma, voice frequency, voice distress, voice malevolence and stress. Conclusion: The findings of the current study suggest that ImRs for PTSD symptoms is generally well tolerated and can be therapeutically beneficial among individuals who hear voices

Managing dissociation in imagery rescripting for voice hearers with trauma: lessons from a case series

Trauma, voice hearing and dissociation tend to be closely linked. Cognitive models of voice hearing largely agree that traumatic events may predispose people to voice hearing via dissociative processes. While treating trauma in voice hearers may help to reduce voice distress and frequency, dissociation may be a barrier to this therapeutic work. This case series reports on the dissociative experiences of a sub-sample of voice hearing clients who reported dissociation during Imagery Rescripting (ImRs) for trauma (N=6, 50% of original sample) in the case series study reported on previously (Paulik, Steel & Arntz, 2019). The aims in the current paper were to explore the impact of dissociation on outcomes, the type of dissociative experiences encountered, where in the ImRs protocol they occurred, and the use of therapeutic techniques to address them. We found that clients who dissociated during therapy showed reductions in their trauma intrusions and voice-related distress and frequency. However, when compared to non-dissociators, these benefits took more sessions to achieve. The most common types of dissociation were flashbacks, losing control over the image, emotional detachment and trance/absorbed state. These were most likely to occur at points during the therapy where negative affect was heightened. Grounding and soothing techniques, as well as strategies to reduce the level of negative affect were reported effective by participants in preventing or interrupting dissociation. We recommend that dissociation should not be a barrier to implementing imagery rescripting with this group

Beyond beliefs : a qualitative study of people’s opinions about their changing relations with their voices

This study sought to develop further understandings of the relationships that people can develop with the voices they hear, and to explore the development of these relationships over time. Qualitative data was gathered from 12 people attending peer support groups. A semi-structured interview was used to facilitate the interviews and analysis of the transcripts was guided by the principles of Thematic Analysis. Four themes emerged and suggested that the relationships between hearers and their voices can have a variable trajectory which is influenced by stress, talking with and about voices, and the acceptance of voices and/or resistance. Clinically, the findings have implications for the training of frontline staff, the provision of peer support and the adaptation of psychological therapies. Future studies should assess whether our findings generalise to more diverse samples of voice hearers and use longitudinal qualitative and quantitative designs to explore change processes in-depth from early to later stages of psychosis.11 page(s

Emotional and non-emotional mental imagery and auditory verbal hallucinations (hearing voices): A systematic review of imagery assessment tools

It is unknown to what extent mental imagery and auditory verbal hallucinations (AVHs) are related. Trials evaluating this issue used both emotional and non-emotional mental imagery tools, thereby complicating outcomes comparisons. Therefore, the present study aimed to systematically review the literature on mental imagery in individuals with AVHs to (1) inventory imagery assessment tools used in this population, (2) to collect information on the relation between emotional and non-emotional mental imagery in all sensory domains and AVHs and (3) to integrate the outcomes of this systematic review in a model of different mental imagery domains and related assessment tools. We conducted a systematic literature search in the PubMed Database. After full-text screening, 17 papers were included. Findings showed that a variety of assessment methods have been used to assess various aspects of mental imagery in people with AVHs, suggesting that there is a lack of agreed theoretical conceptualization of mental imagery and AVHs. In addition, the studies confirmed as was expected that non-emotional mental imagery seemed unrelated to AVHs whereas emotional mental imagery was related to AVHs. Lastly, we proposed a model of mental imagery domains and corresponding assessment methods distinguishing between emotional and non-emotional mental imagery

Multi-modal hallucinations across diagnoses: what relationships do they have with voice-related distress?

BackgroundResearch into hallucinatory experiences has focused primarily upon hallucinations within the auditory modality, to the relative neglect of other modalities. Furthermore, the exploration of auditory hallucinations (or ‘voices’) has focused primarily upon the experiences of people with a diagnosis of psychosis. The presence of multi-modal hallucinations may have implications across diagnoses for levels of distress, formulation and the targeting of psychological interventions.MethodsThis study presents a cross-sectional analysis of observational data from the PREFER survey (N = 335). Linear regression was used to explore the relationships between voice-related distress and the presence, number, type and timing of multi-modal hallucinations.ResultsSimple relationships were not found between distress and the presence of hallucinations in visual, tactile, olfactory or gustatory modalities, or in the number of modalities experienced. When considering the degree to which another modality hallucination was experienced simultaneously with voices, there was some evidence that the degree of co-occurrence with visual hallucinations was predictive of distress.ConclusionsThe co-occurrence of voices with visual hallucinations may be associated with relatively greater distress, but not consistently, and the association between multimodal hallucinations and clinical impact appear complex and potentially variable from individual to individual. Further study of associated variables such as perceived voice power may further illuminate these relationships.</p

Study protocol: a randomised controlled trial of a telephone delivered social wellbeing and engaged living (SWEL) psychological intervention for disengaged youth

Internationally, from 12.2-23.4% of youth (aged 16-24 years) are not in employment, education or training (NEET). These disengaged youth are more likely to experience social exclusion, increased psychological distress and poor quality of life. Youth at risk of disengagement are less likely to access traditional support services, requiring development of innovative interventions.The trial is a single blind, three arm, randomised controlled trial evaluating the effectiveness of a telephone delivered psychological intervention for disengaged youth (12-25 years). Participants will be randomised to receive either (i) SWEL, (ii) Befriending, or (iii) Single Session Psycho-Education. Therapy will be over an 8 week period with a minimum of four and maximum of eight sessions for the SWEL or Befriending conditions, or a single session for the Psycho-Education condition. Outcomes will be assessed at baseline and at 2, 8 and 14-month follow-up with the primary outcome being re-engagement in education, training or employment.This large, multi-site, randomised controlled trial will inform the delivery of services for young people at risk of disengaging from education or training. The provision of psychological therapy by telephone increases access by youth - especially those in rural and remote areas - both to the trial and the treatment, if adopted by services. The outcomes of this trial could have meaningful societal impact for a vulnerable population. It is expected that recruitment, intervention and retention will present challenges for the trial given the focus on disengaged youth.ANZCTR, ACTRN12614001212640 , Registered 18 Nov 2014. Retrospectively registered.Ethics approval has been obtained from the participating institutions. Results of the trial will be submitted for publication in peer reviewed journals and findings presented at scientific conferences and to key service providers and policy makers