Trower Peter, Birchwood Max, Meaden Alan, Byrne Sarah, Nelson Angela, Ross Kerry
School of Psychology, University of Birmingham and Birmingham and Solihull Mental HealthTrust, UK.
Br J Psychiatry. 2004 Apr;184:312-20. doi: 10.1192/bjp.184.4.312.
Command hallucinations are a distressing and high-risk group of symptoms that have long been recognised but little understood, with few effective treatments. In line with our recent research, we propose that the development of an effective cognitive therapy for command hallucinations (CTCH) would be enhanced by applying insights from social rank theory.
We tested the efficacy of CTCH in reducing beliefs about the power of voices and thereby compliance, in a single-blind, randomised controlled trial.
A total of 38 patients with command hallucinations, with which they had recently complied with serious consequences, were allocated randomly to CTCH or treatment as usual and followed up at 6 months and 12 months.
Large and significant reductions in compliance behaviour were obtained favouring the cognitive therapy group (effect size 1.1). Improvements were also observed in the CTCH but not the control group in degree of conviction in the power and superiority of the voices and the need to comply, and in levels of distress and depression. No change in voice topography (frequency, loudness, content) was observed. The differences were maintained at 12 months' follow-up.
The results support the efficacy of cognitive therapy for CTCH.
命令性幻听是一组令人痛苦且具有高风险的症状，长期以来已得到认识，但了解甚少，有效治疗方法也很少。根据我们最近的研究，我们提出，运用社会等级理论的见解将有助于开发一种有效的命令性幻听认知疗法（CTCH）。
在一项单盲随机对照试验中，我们测试了CTCH在减少对幻听力量的信念从而降低依从性方面的疗效。
共有38例有命令性幻听且近期依从幻听导致了严重后果的患者，被随机分配至接受CTCH治疗或常规治疗，并在6个月和12个月时进行随访。
认知治疗组的依从行为有大幅且显著的减少（效应量为1.1）。在对幻听力量和优越性的坚信程度、依从的必要性以及痛苦和抑郁水平方面，CTCH组有改善，而对照组没有。幻听特征（频率、响度、内容）没有变化。这些差异在12个月的随访中得以维持。
结果支持CTCH认知疗法的疗效。
