Centre for Mental Health, Swinburne University, Hawthorn, Victoria, Australia.
Orygen: The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.
Psychol Psychother. 2021 Apr;94 Suppl 2(Suppl 2):408-425. doi: 10.1111/papt.12284. Epub 2020 May 21.
There is mounting evidence that traumatic life events play a role in auditory hallucinations (AH). Theory suggests that some AH are decontextualized trauma memory intrusions. Exposure-based trauma-focused therapies that target trauma memory intrusions may therefore be a promising new treatment. We aimed to assess the feasibility and acceptability of a standard protocol trauma-focused imaginal exposure intervention for trauma-related AH and to provide initial proof of concept regarding potential effects on AH.
We conducted a single-arm case series of a six session (90 min per session) imaginal exposure intervention for trauma-related AH with assessments at baseline, post-therapy, and one-month follow-up.
Fifteen people were recruited and eligible to start the intervention. Participants reported high levels of satisfaction; however, temporary distress and symptom exacerbation were common and contributed to discontinuation. There was a large reduction in AH severity at one-month follow-up (adjusted d = 0.99), but individual response was highly variable. There were also large reductions in post-traumatic stress disorder symptoms and the intrusiveness of the trauma memory.
Imaginal exposure for trauma-related AH is generally acceptable and may have large effects on AH severity for some people. However, temporary distress and symptom exacerbation are common and can lead to discontinuation. Low referral rates and uptake also suggest feasibility issues for standalone imaginal exposure for AH. The intervention may be more feasible and acceptable in the context of a broader trauma-focused therapy. Well-powered trials are needed to determine efficacy and factors that impact on acceptability and therapy response.
Some AH can be understood as trauma memory intrusions that lack temporal and spatial contextualization and are therefore experienced without autonoetic awareness. Imaginal exposure to trauma memories associated with AH may be an effective intervention for some people. Temporary distress and symptom exacerbation may be common when using standard trauma-focused imaginal exposure for AH. This can impact on the acceptability of the therapy and should be considered in future development and delivery.
越来越多的证据表明，创伤性生活事件在幻听（AH）中起作用。理论表明，一些 AH 是去情境化的创伤记忆入侵。因此，针对创伤记忆入侵的基于暴露的创伤聚焦疗法可能是一种有前途的新治疗方法。我们旨在评估针对创伤相关 AH 的标准方案创伤聚焦想象暴露干预的可行性和可接受性，并提供关于 AH 潜在影响的初步概念验证。
我们进行了一项创伤相关 AH 的六次想象暴露干预（每次 90 分钟）的单臂病例系列研究，在基线、治疗后和一个月随访时进行评估。
招募了 15 名符合条件的参与者开始干预。参与者报告满意度高；然而，暂时的困扰和症状恶化很常见，导致退出。在一个月的随访时，AH 严重程度有很大的降低（调整后的 d=0.99），但个体反应高度可变。创伤后应激障碍症状和创伤记忆的侵入性也有很大的降低。
针对创伤相关 AH 的想象暴露通常是可以接受的，并且对某些人来说可能对 AH 严重程度有很大的影响。然而，暂时的困扰和症状恶化很常见，可能导致退出。低转诊率和参与率也表明，单独使用想象暴露治疗 AH 存在可行性问题。在更广泛的创伤聚焦治疗背景下，该干预可能更可行和可接受。需要进行更大规模的试验来确定疗效以及影响可接受性和治疗反应的因素。
一些 AH 可以被理解为创伤记忆入侵，缺乏时间和空间情境化，因此没有自主意识体验。针对与 AH 相关的创伤记忆进行想象暴露可能对某些人有效。当使用标准的创伤聚焦想象暴露治疗 AH 时，暂时的困扰和症状恶化可能很常见。这会影响治疗的可接受性，在未来的开发和提供中应予以考虑。
