Cognitive behavioural therapy for auditory hallucinations in schizophrenia: A review

Table 1 Randomized clinical trials of cognitive behavioral therapy for auditory hallucinations

Ref.	Sample	Methods	Criteria for diagnosis	Criteria for outcome	Focused treatment	Results	Follow-up
Shawyer et al[14]	n = 44 Mean age: 39	RCT	(1) diagnosis of schizophrenia or related condition based on DSM-IV criteria (2) command hallucinations within the previous 6 mo that caused distress or dysfunction despite treatment with antipsychotic medication at therapeutic doses	Assessor-rated degree of compliance with harmful command hallucinations on a scale of 0-7 Self-rated confidence to resist obeying harmful commands and confidence in coping with general commands on a scale of 0-100 PANSS Modified GAF PSYRATS Quality of Life Enjoyment and Satisfaction Questionnaire Client Satisfaction Questionnaire VAAS BAVQ-R 8-item self-report Insight Scale RSQ	Randomized to 15 sessions of the intervention “TORCH” or the control, Befriending. A sub-sample of 17 participants was randomized to a waitlist control before being allocated to TORCH or Befriending Pharmacological treatment: Chlorpromazine equivalent dose (mg) Mean = 742.9 SD = 388.7	Confidence to resist harmful CHs (P = n.s.) Confidence in coping with CHs (P < 0.01) PANSS total (P < 0.05) Modified GAF (P = n.s.) Distress PSYRATS (P < 0.01) Disruption PSYRATS (P < 0.01) Quality of Life ( P < 0.05) VAAS (P = n.s.) BAVQ-R (P = n.s.)	6-mo
Birchwood et al[15]	n = 197 Mean age: 37.4	RCT	(1) ICD-10 schizophrenia, schizoaffective, or mood disorders, under care of a clinical team (2) history of harmful command hallucinations of at least 6 mo duration with recent (< 9 mo) history of harm to self, others or major social transgressions as a result of the commands (full or partial compliance); or harmful command hallucinations where the individual is distressed and appeasing the powerful voice	VCS VPD Personal knowledge questionnaire/omniscience scale BAVQ-R PSYRATS Calgary Depression Rating Scale for Schizophrenia Beck Hopeleness Scale Beck Scale for Suicidal Ideation PANSS	Randomized to cognitive Therapy for command Hallucinations + treatment as usual or treatment as usual alone Adherence to cognitive therapy was excellent: only 12 (12%) of 98 participants not attending any sessions, and 79 (81%) completing the therapy (all manualised elements) Pharmacological treatment: Olanzapine equivalents dose (mg) 25.79 (SD: 21.73).	RSQ (P = n.s.) VCS experimental group: 41; control group: 49 VPD total, experimental group: 21.31; control group: 23.98 Personal knowledge questionnaire (P = 0.09) BAVQ-R (P = n.s.) PSYRATS total (P = n.s.) Calgary Depression Rating Scale for Schizophrenia (P = n.s.) Beck Scale for Suicidal Ideation (P = n.s.) PANSS total (P = n.s.)	18-mo

AHs: Auditory hallucinations; BAVQ-R: Beliefs about the voices questionnaire-revised; CHs: Command hallucinations; GAF: Global assessment of functioning scale; n.s.: Not significant; PANSS: Positive and negative syndrome scale; RCT: Randomized clinical trial; PSYRATS: Psychotic symptom rating scale; RSQ: Recovery style questionnaire; VAAS: Voices acceptance and action scale; VCS: Voice compliance scale; VPD: Voice power differential scale.