Auditory Hallucinations Project

Julian Leff, Mark Huckvale, Geoff Williams

Funded 2009-2011 by the National Institute for Health Research

NEW Clinical Trial Project described here.

Development and testing of a computer-assisted system to reduce auditory hallucinations

Introduction

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 patients’ 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.

Aims

1. To develop a computer-based technology that will help the clinician to treat more effectively the auditory hallucinations of schizophrenia and manic-depressive psychosis.
2. To evaluate this technology in a randomised controlled trial.

Method

The methodology is designed to tackle the problem created by the inaccessibility of the patients' experience of voices to the clinician. Patients troubled by persistent distressing auditory hallucinations will be invited to create an external representation of their dominant voice hallucination using computer technology. Graphics software will be used to create an avatar that will give a face to the voice, while voice morphing software will realise it in sound. The researcher can then use text-to-speech and animation software to cause the avatar to respond to the patient's speech, creating a dialogue in which the voice progressively comes under the patient's control.

References

• Barbato, A. (1998) Schizophrenia and Public Health. Geneva: World Health Organization.
• Drury, V., Birchwood, M., Cochrane, R. & Macmillan, F. (1996) Cognitive therapy and recovery from acute psychosis: a controlled trial. I. Impact on psychotic symptoms. Brit J Psychiatry, 169, 593-601.
• Durham,R.C., Guthrie, M. et al. (2003) Tayside Fife clinical trial of cognitive-behavioural therapy for medication-resistant psychotic symptoms. Brit J Psychiatry, 182, 303-311.
• Kane, J. M. (1996) Treatment resistant schizophrenic patients. J Clin Psychol, 57 (suppl. 9), 35-40.
• Kuipers, E., Fowler, D. et al (1998) London-East Anglia randomised controlled trial of cognitive-behavioural therapy for psychosis. III: follow-up and economic evaluation at 18 months. Brit J Psychiatry, 173, 61-68.
• Nayani, T.H., David, A.S. (1996) The auditory hallucination: a phenomenological study. Psychological Medicine, 26, 177-189.
• Sensky, T., Turkington, D. et al (2000) A randomised controlled trial of cognitive behavioural therapy for persistent symptoms in schizophrenia resistant to medication. Arch Gen Psychiatry, 57, 165-172.
• Tarrier, N., Beckett, R. et al (1993) A trial of two cognitive behavioural methods of treating drug-resistant psychotic symptoms in schizophrenic patients. I: Outcome. Brit J Psychiatry, 162, 524-532.
• Trower, P., Birchwood, M. et al (2004) Cognitive therapy for command hallucinations: randomised controlled trial. Brit J Psychiatry, 184, 312-320.
• Turkington, D., Kingdon, D. et al (2006) Outcomes of an effectiveness trial of cognitive behavioural intervention by mental health nurses in schizophrenia. Brit J Psychiatry, 189, 36-40.