Auditory Hallucinations Project
Funded 2009-2011 by the National Institute for Health Research
Development and testing of a computer-assisted system to reduce auditory hallucinations
Auditory hallucinations are an enduring problem in the treatment of serious mental illness such as schizophrenia. About 30% of people with this diagnosis continue to experience hallucinations and delusions despite treatment with antipsychotic medication (Kane, 1996). Hearing voices is not only distressing to the sufferers, it also has a serious impact on carers and members of the public. The rare instances of violence against relatives or members of the public are often provoked by 'voices'. Persistent voices also severely limit the patientsí ability to concentrate on tasks and hence hinder attempts at rehabilitation. The direct treatment costs in the United Kingdom are estimated at £2 billion annually, while the indirect costs, including loss of employment for the patients and carers, amount to another £2 billion (Barbato, 1998).
In the past 15 years in Britain there has been a development of cognitive and behavioural approaches to the control of persistent psychotic symptoms. A number of randomised controlled trials (RCTs) have been conducted to test the value of cognitive-behavioural therapy (CBT) for persistent medication-resistant symptoms of psychosis (Tarrier et al, 1993; Drury et al, 1996; Kuipers et al, 1997; 1998; Sensky et al, 2000). While these have shown some effect in reducing auditory hallucinations, they have been criticised on the grounds that they failed to control for therapist contact time, or controlled for it but with the same therapists delivering both the experimental and control therapies (Durham et al, 2003). Two recent RCTs of CBT with more rigorous designs failed to show any effect on auditory hallucinations (Durham et al, 2003; Turkington et al, 2006).
On the other hand, one recent RCT of CBT, while not affecting the frequency of auditory hallucinations, did succeed in reducing the power of the dominant voice as perceived by the patients, and their distress (Trower et al, 2004). This suggests that CBT could provide some benefit if applied to specific aspects of the hallucinations. In this study we are building on earlier work (Nayani & David, 1996) which showed that clients who spontaneously developed a dialogue with any of their voices felt more in control of them.
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