Ruddle A, Livingstone S, Huddy V, Johns L, Stahl D, Wykes T
Research Department of Clinical, Educational and Health Psychology, University College London, UKDepartment of Psychology, Institute of Psychiatry, King's College London, UKCOAST, Westways Resource Centre, 49 St James Road, Croydon CR0 2UR, UK.
Psychol Psychother. 2014 Mar;87(1):60-79. doi: 10.1111/j.2044-8341.2012.02074.x. Epub 2012 Jun 12.
Hearing voices groups (HVGs) are increasingly common in National Health Services and are often preferred to individual therapy by both service users and providers. Whilst a range of approaches exist, mixed results have been found and only cognitive behaviour therapy (CBT) was supported by well-controlled trials. This study aimed to explore possible predictors and mechanisms of change in a seven-session CBT group for voice hearers.
An exploratory case series design was used. Method. Fifteen outpatients with a diagnosis of schizophrenia or schizoaffective disorder completed a HVG and carried out weekly measures of distress, negative beliefs about voices, self-esteem, effective coping strategies, and activity levels. Visual inspection and quantitative rules were used to group participants with similar results and cross-correlations and t tests were used to verify key findings.
Several pathways emerged across therapy. Despite measurement frequency, changes on different outcomes tended to occur simultaneously, making conclusions about mechanisms difficult. However, changes in beliefs about voice malevolence and omnipotence correlated most frequently with changes in distress. Visual analysis indicated 53% of participants improved on a measured outcome but satisfaction scores were higher, with 93% feeling the group helped them deal with their problems more effectively. Clients especially valued the chance to meet similar others.
The results suggest HVGs are valued by clients, regardless of their background or symptoms. HVGs should emphasize testing negative beliefs about voices and allow space for supportive discussions between clients. Recommendations for future research are discussed, including consideration of benefits not detected by outcome measures.
在国民医疗服务体系中，幻听群体（HVGs）越来越常见，服务使用者和提供者通常都更倾向于团体治疗而非个体治疗。虽然存在多种治疗方法，但研究结果不一，只有认知行为疗法（CBT）得到了严格对照试验的支持。本研究旨在探索针对幻听者的七节CBT团体治疗中可能的预测因素和改变机制。
采用探索性病例系列设计。方法。15名被诊断为精神分裂症或分裂情感性障碍的门诊患者完成了一个幻听团体治疗，并每周测量痛苦程度、对幻听的消极信念、自尊、有效应对策略和活动水平。通过视觉检查和定量规则对结果相似的参与者进行分组，并使用交叉相关性和t检验来验证关键发现。
在整个治疗过程中出现了几种途径。尽管测量频率较高，但不同结果的变化往往同时发生，难以得出关于机制的结论。然而，对幻听恶意和全能性的信念变化与痛苦程度的变化最常相关。视觉分析表明，53%的参与者在一项测量结果上有所改善，但满意度得分更高，93%的人认为团体治疗帮助他们更有效地处理问题。客户尤其重视与其他有相似经历的人见面的机会。
结果表明，无论背景或症状如何，幻听群体治疗都受到客户的重视。幻听群体治疗应强调检验对幻听的消极信念，并为客户之间的支持性讨论留出空间。讨论了对未来研究的建议，包括考虑结果测量未检测到的益处。
