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- Title
Targeting dissociation using cognitive behavioural therapy in voice hearers with psychosis and a history of interpersonal trauma: A case series.
- Authors
Varese, Filippo; Douglas, Maggie; Dudley, Robert; Bowe, Samantha; Christodoulides, Thomas; Common, Stephanie; Grace, Tim; Lumley, Victoria; McCartney, Laura; Pace, Sonia; Reeves, Thomas; Morrison, Anthony P.; Turkington, Douglas
- Abstract
Objectives: Previous studies have suggested that dissociation might represent an important mechanism in the maintenance of auditory verbal hallucinations (i.e., voices) in people who have a history of traumatic life experiences. This study investigated whether a cognitive behavioural therapy (CBT) intervention for psychosis augmented with techniques specifically targeting dissociative symptoms could improve both dissociation and auditory hallucination severity in a sample of voice hearers with psychosis and a history of interpersonal trauma (e.g., exposure to sexual, physical, and/or emotional abuse). Design: Case series. Methods: A total of 19 service users with psychosis were offered up to 24 therapy sessions over a 6‐month intervention window. Participants were assessed four times over a 12‐month period using measures of dissociation, psychotic symptoms severity, and additional secondary mental‐health and recovery measures. Results: Sixteen participants engaged in the intervention and were included in last‐observation‐carried‐forward analyses. Dropout rates were in line with those of other CBT for psychosis trials (26.3%). Repeated measures ANOVAs revealed large and significant improvements in dissociation (drm = 1.23) and hallucination severity (drm = 1.09) by the end of treatment; treatment gains were maintained 6 months following the end of therapy. Large and statistically significant gains were also observed on measures of post‐traumatic symptoms, delusion severity, emotional distress, and perceived recovery from psychosis. Conclusions: The findings of this case series suggest that the reduction of dissociation represents a valuable and acceptable treatment target for clients with auditory verbal hallucinations and a trauma history. Future clinical trials might benefit from considering targeting dissociative experiences as part of psychological interventions for distressing voices. Practitioner points: Practitioners should consider the role of dissociation when assessing and formulating the difficulties of voice hearers with a history of trauma.Techniques to reduce dissociation can be feasibly integrated within psychological interventions for voices.Voice hearers with histories of trauma can benefit from psychological interventions aimed at reducing dissociation.
- Subjects
HALLUCINATIONS; ANALYSIS of variance; DISSOCIATIVE disorders; PSYCHOSES; CONVALESCENCE; BEHAVIOR therapy; INTERPERSONAL relations; PSYCHOSOCIAL factors; REPEATED measures design; DESCRIPTIVE statistics; WOUNDS &; injuries; COGNITIVE therapy
- Publication
Psychology & Psychotherapy: Theory, Research & Practice, 2021, Vol 94, Issue 2, p247
- ISSN
1476-0835
- Publication type
Article
- DOI
10.1111/papt.12304