Mental Health and Wellbeing,Warwick Medical School,University of Warwick,Coventry,UK.
Centre for Biostatistics,Institute of Population Health,University of Manchester,Manchester,UK.
Psychol Med. 2018 Sep;48(12):1966-1974. doi: 10.1017/S0033291717003488. Epub 2017 Dec 5.
Acting on harmful command hallucinations is a major clinical concern. Our COMMAND CBT trial approximately halved the rate of harmful compliance (OR = 0.45, 95% CI 0.23-0.88, p = 0.021). The focus of the therapy was a single mechanism, the power dimension of voice appraisal, was also significantly reduced. We hypothesised that voice power differential (between voice and voice hearer) was the mediator of the treatment effect.
The trial sample (n = 197) was used. A logistic regression model predicting 18-month compliance was used to identify predictors, and an exploratory principal component analysis (PCA) of baseline variables used as potential predictors (confounders) in their own right. Stata's paramed command used to obtain estimates of the direct, indirect and total effects of treatment.
Voice omnipotence was the best predictor although the PCA identified a highly predictive cognitive-affective dimension comprising: voices' power, childhood trauma, depression and self-harm. In the mediation analysis, the indirect effect of treatment was fully explained by its effect on the hypothesised mediator: voice power differential.
Voice power and treatment allocation were the best predictors of harmful compliance up to 18 months; post-treatment, voice power differential measured at nine months was the mediator of the effect of treatment on compliance at 18 months.
对有害命令性幻觉采取行动是一个主要的临床关注点。我们的 COMMAND CBT 试验将有害顺从的发生率降低了近一半（OR=0.45，95%CI 0.23-0.88，p=0.021）。治疗的重点是单一机制，即声音评估的权力维度也显著降低。我们假设声音权力差异（声音和声音倾听者之间）是治疗效果的中介。
使用了试验样本（n=197）。使用逻辑回归模型预测 18 个月的顺从性，以确定预测因素，并对基线变量进行探索性主成分分析（PCA），作为潜在的预测因素（混杂因素）。使用 Stata 的 paramed 命令来获得治疗的直接、间接和总效应的估计值。
声音全能性是最好的预测因素，尽管 PCA 确定了一个具有高度预测性的认知-情感维度，包括：声音的力量、童年创伤、抑郁和自残。在中介分析中，治疗的间接效应完全可以用它对假设的中介物的影响来解释：声音权力差异。
声音权力和治疗分配是 18 个月内有害顺从的最佳预测因素；治疗后，九个月时测量的声音权力差异是治疗对 18 个月时顺从的影响的中介。
