School of Psychology, Curtin University, Curtin, Western Australia, Australia.
Department of Clinical Psychology, University of Amsterdam, Netherlands & Academic Center for Trauma and Personality, Amsterdam, Netherlands.
Clin Psychol Psychother. 2024 Sep-Oct;31(5):e3052. doi: 10.1002/cpp.3052.
People who hear voices (auditory verbal hallucinations) often have post-traumatic stress disorder (PTSD) symptoms. Cognitive behavioural therapies (CBT) have yielded inconsistent findings when treating voices and PTSD symptoms in voice hearers. Preliminary evidence suggests imagery rescripting (ImRs) is associated with large reductions in voice hearing and PTSD symptoms. This study replicated past studies using a larger sample to examine the effectiveness of ImRs in reducing such symptoms.
Participants (N = 49; 65.3% female; M = 35.86) were clients at an Australian transdiagnostic clinic for voice hearers. A one-arm open trial design was used with three pre-treatment baselines and a mid-treatment, post-treatment and 3-month follow up assessments of PTSD symptoms (Posttraumatic Diagnostic Scale for DSM-5), voices (Hamilton Program for Schizophrenia Voices Questionnaire) and emotional symptoms (Depression Anxiety and Stress Scales-21). Five single-item measures were administered weekly to explore the trajectories of change in trauma intrusions, voice-related distress, voice frequency and positive and negative voice valance.
ImRs was associated with very large reductions in PTSD symptoms and voices (both emotional and physical characteristics of voices) and emotional symptoms at post-treatment and follow-up (η = 0.24-0.44). There were medium-large to large reductions in weekly symptoms of intrusions, voice-related distress, voice frequency and negative voices (η = 0.12-0.16) and a non-significant increase in positive voices (η = 0.05).
This study provides further evidence that ImRs is an effective treatment for voices and PTSD symptoms in voice hearers with a range of diagnoses. Randomised controlled trials are needed to compare the efficacy of ImRs to CBT protocols.
出现幻听（听觉言语幻觉）的人通常患有创伤后应激障碍（PTSD）症状。认知行为疗法（CBT）在治疗幻听和 PTSD 症状方面的效果并不一致。初步证据表明，意象重述（ImRs）与幻听和 PTSD 症状的大幅减少有关。本研究使用更大的样本复制了过去的研究，以检验 ImRs 在减少这些症状方面的有效性。
参与者（N=49；65.3%为女性；M=35.86）是澳大利亚一家用于治疗幻听的跨诊断诊所的客户。采用单臂开放试验设计，在治疗前有三个基线期，以及 PTSD 症状（DSM-5 创伤后诊断量表）、幻听（精神分裂症 Hamilton 幻听问卷）和情绪症状（抑郁焦虑和压力量表-21）的治疗后和 3 个月随访评估。每周还进行了五项单项措施评估，以探讨创伤性闯入、与幻听相关的痛苦、幻听频率以及正负幻听效价的变化轨迹。
ImRs 与 PTSD 症状以及幻听（包括幻听的情绪和身体特征）和情绪症状的显著减少相关，在治疗后和随访时（η=0.24-0.44）。创伤性闯入、与幻听相关的痛苦、幻听频率和负性幻听的每周症状均有较大幅度的减少（η=0.12-0.16），而正性幻听的减少则不显著（η=0.05）。
本研究进一步证明，ImRs 是一种有效的治疗幻听和 PTSD 症状的方法，适用于多种诊断的幻听患者。需要进行随机对照试验来比较 ImRs 与 CBT 方案的疗效。
