Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK.
College of Medicine and Dentistry, University of Birmingham, Birmingham, UK.
BMJ Open. 2018 Jun 15;8(6):e021657. doi: 10.1136/bmjopen-2018-021657.
To explore service user experiences of a 9-month cognitive behavioural therapy for command hallucinations in the context of a randomised controlled trial including their views on acceptability and tolerability of the intervention.
Qualitative study using semistructured interviews.
The study took place across three sites: Birmingham, Manchester and London. Interviews were carried out at the sites where therapy took place which included service bases and participants' homes.
Of 197 patients who consented to the trial, 98 received the Cognitive Behavior Therapy for Command Hallucinations (CTCH) intervention; 25 (15 males) of whom were randomly selected and consented to the qualitative study. The mean age of the sample was 42 years, and 68% were white British.
Two superordinate themes were identified: participants' views about the aspects of CTCH they found most helpful; and participants' concerns with therapy. Helpful aspects of the therapy included gaining control over the voices, challenging the power and omniscience of the voices, following a structured approach, normalisation and mainstreaming of the experience of voices, and having peer support alongside the therapy. Concerns with the therapy included anxiety about completing CTCH tasks, fear of talking back to voices, the need for follow-up and ongoing support and concerns with adaptability of the therapy.
Interpretation: CTCH was generally well received and the narratives validated the overall approach. Participants did not find it an easy therapy to undertake as they were challenging a persecutor they believed had great power to harm; many were concerned, anxious and occasionally disappointed that the voices did not disappear altogether. The trusting relationship with the therapist was crucial. The need for continued support was expressed.
ISRCTN62304114, Pre-results.
在一项包括对干预措施的可接受性和耐受性的看法的随机对照试验的背景下，探索服务使用者对为期 9 个月的针对命令性幻觉的认知行为疗法的体验。
使用半结构化访谈的定性研究。
研究在三个地点进行：伯明翰、曼彻斯特和伦敦。访谈在治疗地点进行，包括服务基地和参与者的家。
在同意参加试验的 197 名患者中，有 98 名接受了认知行为疗法治疗命令性幻觉（CTCH）干预；其中随机选择并同意参加定性研究的有 25 名（15 名男性）。样本的平均年龄为 42 岁，68%为白种英国人。
确定了两个上级主题：参与者对他们认为最有帮助的 CTCH 方面的看法；以及参与者对治疗的关注。治疗的有益方面包括对声音的控制、对声音的力量和全知的挑战、遵循结构化的方法、声音体验的正常化和主流化，以及在治疗过程中获得同伴支持。对治疗的关注包括对完成 CTCH 任务的焦虑、对回怼声音的恐惧、对随访和持续支持的需求，以及对治疗适应性的担忧。
解释：CTCH 总体上得到了很好的接受，叙述验证了总体方法。参与者认为与他们认为有很大能力伤害他们的迫害者作斗争并不容易；许多人担心、焦虑，有时对声音没有完全消失感到失望。与治疗师建立信任关系至关重要。需要持续支持。
ISRCTN62304114，预结果。
