Perth Voices Clinic, School of Psychological Science, University of Western Australia, Crawley, Australia.
School of Psychology and Exercise Science, Murdoch University, Murdoch, Australia.
Clin Psychol Psychother. 2018 Sep;25(5):634-640. doi: 10.1002/cpp.2299. Epub 2018 May 24.
Cognitive behaviour therapy is recommended internationally as a treatment for psychosis (targeting symptoms such as auditory hallucinations, or "voices"). Yet mental health services are commonly unable to offer such resource-intensive psychological interventions. Brief, symptom-specific and less resource-intensive therapies are being developed as one initiative to increase access. However, as access increases, so might the risk of offering therapy to clients who are not optimally disposed to engage with and benefit from therapy. Thus, it is important to identify who is most/least likely to engage with and benefit from therapy, and when. In the current study, 225 clients were assessed for suitability for a brief, 4-session, manualized, cognitive behaviour therapy-based intervention for voices (named coping strategy enhancement therapy) and 144 commenced therapy, at a transdiagnostic voices clinic based in Sussex, UK. This article reports on the value of depression, anxiety, stress, insight into the origin of voices, length of voice hearing, and demographics in the prediction of engagement and outcomes. The study found that higher levels of baseline depression, anxiety, and stress were significantly associated with poorer outcomes, especially if clients also had high levels of voice-related distress. The engagement analyses showed that levels of voice-related distress at baseline predicted dropout. These findings highlight the importance of assessing negative affect and voice-related distress prior to commencing therapy for distressing voices, to help determine if the client is suitable or ready for brief-coping strategy enhancement.
认知行为疗法被国际推荐为治疗精神病的一种方法（针对听觉幻觉等症状，即“声音”）。然而，心理健康服务机构通常无法提供这种资源密集型的心理干预。简短、特定症状和资源密集度较低的治疗方法正在作为增加获得途径的一种措施而被开发。然而，随着获得途径的增加，向那些不太愿意参与和受益于治疗的客户提供治疗的风险也可能会增加。因此，确定谁最有可能/最不可能参与和受益于治疗，以及何时参与和受益于治疗是很重要的。在当前的研究中，225 名患者在英国苏塞克斯的一家基于认知行为疗法的简短、4 节、手册化的干预性声音治疗诊所（名为应对策略增强治疗）中进行了适合性评估，并为 144 名患者开始了治疗。本文报告了抑郁、焦虑、压力、对声音来源的洞察力、声音持续时间和人口统计学在预测参与和结果方面的价值。研究发现，基线时较高的抑郁、焦虑和压力水平与较差的结果显著相关，尤其是当患者也有较高的与声音相关的困扰时。参与度分析表明，基线时与声音相关的困扰程度预测了脱落。这些发现强调了在开始针对困扰性声音的简短应对策略增强治疗之前，评估负面情绪和与声音相关的困扰的重要性，以帮助确定患者是否适合或准备好进行简短的治疗。
