Smailes David, Alderson-Day Ben, Fernyhough Charles, McCarthy-Jones Simon, Dodgson Guy
Department of Psychology, Durham UniversityDurham, UK; Department of Psychology, Leeds Trinity UniversityLeeds, UK.
Department of Psychology, Durham University Durham, UK.
Front Psychol. 2015 Dec 21;6:1933. doi: 10.3389/fpsyg.2015.01933. eCollection 2015.
Cognitive behavioral therapy (CBT) for voice-hearing (i.e., auditory verbal hallucinations; AVH) has, at best, small to moderate effects. One possible reason for this limited efficacy is that current CBT approaches tend to conceptualize voice-hearing as a homogenous experience in terms of the cognitive processes involved in AVH. However, the highly heterogeneous nature of voice-hearing suggests that many different cognitive processes may be involved in the etiology of AVH. These heterogeneous voice-hearing experiences do, however, appear to cluster into a set of subtypes, opening up the possibility of tailoring treatment to the subtype of AVH that a voice-hearer reports. In this paper, we (a) outline our rationale for tailoring CBT to subtypes of voice-hearing, (b) describe CBT for three putative subtypes of AVH (inner speech-based AVH, memory-based AVH, and hypervigilance AVH), and (c) discuss potential limitations and problems with such an approach. We conclude by arguing that tailoring CBT to subtypes of voice-hearing could prove to be a valuable therapeutic development, which may be especially effective when used in early intervention in psychosis services.
针对幻听（即听幻觉；AVH）的认知行为疗法（CBT），其效果充其量只是有小到中等程度的影响。疗效有限的一个可能原因是，当前的CBT方法倾向于将幻听在涉及AVH的认知过程方面概念化为一种同质体验。然而，幻听的高度异质性表明，许多不同的认知过程可能参与到AVH的病因中。不过，这些异质性的幻听体验似乎确实聚集成了一组亚型，这为根据幻听者报告的AVH亚型量身定制治疗方案开辟了可能性。在本文中，我们（a）概述了针对幻听亚型量身定制CBT的基本原理，（b）描述了针对三种假定的AVH亚型（基于内心言语的AVH、基于记忆的AVH和过度警觉性AVH）的CBT，以及（c）讨论了这种方法的潜在局限性和问题。我们最后指出，针对幻听亚型量身定制CBT可能会被证明是一项有价值的治疗进展，在精神病服务的早期干预中使用时可能会特别有效。
