Psychotic Disorders Clinical Trial
Official title:
Cognitive Therapy for Distressing Visual Hallucinations: A Pilot Study
The study is a pilot study of Cognitive therapy for people with psychosis who have distressing visual hallucinations. The aim is to evaluate whether this is an acceptable, feasible and effective treatment. This is a pilot study and there is no randomisation to either CBT or treatment as usual (TAU). If a participant is allocated to the cognitive therapy plus TAU condition then the participant will meet with a therapist on initially a weekly basis and receive up to 8 sessions of CBT over a 2 month period. The participant will also have regular assessments conducted by a researcher who is independent to the treatment group. It is predicted that those people receiving CBT will improve on measures of symptoms, and particularly for measures of visual hallucinations.
Cognitive behavioural therapy (CBT) has been proven to be effective in helping people with
distressing psychotic symptoms such as auditory hallucinations or upsetting delusional
beliefs. While the majority of hallucinations reported in psychotic disorders are auditory,
visual hallucinations (VH) have been reported in 16%-72% of people with psychotic disorders
like schizophrenia and schizoaffective disorder. VH appear to be associated with particularly
high levels of distress, and impairment. The global severity of illness was significantly
higher in people with schizophrenia and VH, as compared to those people without VH. Whilst
antipsychotic medication is the first line of treatment for psychotic symptoms like VH, there
is evidence that many service users choose to refuse or discontinue their pharmacological
treatment. For example, the largest trial to compare atypical antipsychotics found that 74%
of patients with a diagnosis of schizophrenia discontinued their medication over 18 months.
Hence, there is a need to develop a range of effective treatments. Despite its value in
treating auditory hallucinations, at present there is no specific CBT treatment for VH.
We developed a cognitive behavioural model for visual hallucinations. This model has been
tested in a recent study of 15 people with psychosis and distressing visual hallucinations
which found that it was not the presence of the visual experience per se that led to the
distress but the appraisal of it (as being a threat to psychological or physical wellbeing).
Such appraisals are targeted in CBT for auditory hallucinations.
The aim of this research is to assess the value of a manualised cognitive behavioural
intervention for distressing visual hallucinations by establishing if it reduces distress and
disability. The aim is to determine the acceptability of the treatment package, feasibility
of recruitment, the ability to deliver the treatment manual as intended, retention in the
treatment, a preliminary estimate of effect size and maintenance of any gains at a brief
follow up.
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