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)?
Answer:
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.