Question: In adults of working age who hear distressing voices, how effective are CBT based, hearing voice groups, compared to treatment as usual, in improving patient outcomes (such as improving coping strategies, providing a sense of hope, increasing understanding of voice hearing and reducing service dependency)?


One high quality Cochrane review, and two additional small, poor quality randomised controlled trials (RCTs) provided data to inform this evidence summary. The Cochrane review assessed the effectiveness of all forms of cognitive behavioural therapy (CBT), compared to other psychosocial interventions, in people with schizophrenia and found no significant treatment effects for CBT (mortality, relapse, re-hospitalisation, mental state measures, social functioning, and quality of life). This review included 20 RCTs, only one of which assessed a group CBT intervention and specifically stated that the intervention targeted auditory hallucinations, however, this study also found no treatment effect for CBT on any on the outcome measures assessed (mental state measures, relapse, or re-hospitalisation). The two small RCTs both compared group CBT with usual care in people with schizophrenia and auditory hallucinations. Both RCTs reported some positive conclusions with respect to improvements in auditory hallucinations associated with group CBT, however, in neither case were these conclusions adequately supported by the data presented. There was some very limited evidence, from one small RCT, for an improvement in social functioning associated with group CBT. Overall, evidence on the effectiveness of group CBT in adults who hear voices is very limited and does not support a significant effect on auditory hallucinations.

Larger, high quality randomised controlled trials are needed to provide reliable assessments of the effectiveness of CBT which targets auditory hallucinations, and in particular group CBT, for the treatment of adults who hear voices.


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