Imagery Interventions for Auditory Vocal Hallucinations
NCT ID: NCT05603260
Last Updated: 2024-02-28
Study Results
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Basic Information
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COMPLETED
NA
32 participants
INTERVENTIONAL
2022-04-07
2024-02-10
Brief Summary
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Detailed Description
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The main objective of this study is to assess the feasibility, acceptability, and effectiveness of four imagery intervention techniques (metacognitive imagery intervention, imagery rescripting, promoting positive imagery and competing imagery task) for auditory vocal hallucinations. The investigators are primarily interested in whether these imagery intervention techniques would be associated with a decrease in auditory vocal hallucinations and imagery symptoms. Also, the investigators are interested in whether these imagery intervention techniques would be a feasible and acceptable intervention for patients with a disorder in the transdiagnostic psychosis and suffering from auditory hallucinations. Secondly, the investigators aim to assess the effects on the level of delusions, visual hallucinations and social and occupational functioning. Lastly, the investigators aim to explore the working mechanisms of imagery, affective symptomatology, and auditory vocal hallucinations by three times daily measuring these symptoms for a period of seven weeks.
The investigators hypothesise that 1) all four imagery interventions are associated with a significant decrease in AVHs (e.g., a decline in the level of auditory vocal hallucinations) and imagery characteristics (e.g., decline in imagery frequency, imagery appraisals and imagery quality), whereas no serious adverse side-effects would occur, drop-out rates of therapy are low and patients will give a good qualitative review of therapy. 2) Psychotic symptoms decrease and social and occupational functioning increase after treatment. 3) The severity of emotional imagery is positively associated with the severity AVHs. In addition, the investigators hypothesize that this association may be different for different imagery aspects, with stronger associations between imagery appraisals (i.e., the encapsulated beliefs, and metacognitive beliefs) and the severity of AVHs as compared to other imagery aspects (frequency and quality aspects). And 4) The associations between imagery related factors and the severity of AVHs are mediated by the level of symptoms of anxiety and depression.
The primary outcome variables, the level of auditory vocal hallucinations and imagery characteristics, are calculated using daily measurements during a two-week baseline, during the intervention and after the end of intervention at follow-up at 7 weeks. Most secondary outcome variables are assessed using self-report measures before baseline, and at pre- and post-intervention.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
TREATMENT
SINGLE
Study Groups
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Meta-cognitive imagery rescripting techniques (M-Int)
These techniques are developed to reduce the power of an image by changing how the client responds to an image by shifting attention away from it, or by doing something that reinforces that it is just an image and not "real".
Imagery intervention for voice hearing (meta-cognitive imagery rescripting)
The participants receive intervention for a period of 3 weeks, 6 sessions of 60 minutes.
In-depth identification of images (2 sessions): Identifying imagery which is related to the auditory vocal hallucinations, constructing a micro-formulation with the participant along the lines of regular Cognitive Behavioural Therapy. In this micro-formulation, first triggers of problematic imagery are identified, both quality and appraisals of this image are identified. Subsequent maladaptive behaviour and possible links with earlier experiences are described, as well as maintaining factors.
Imagery intervention (2 sessions): The imagery intervention consists of meta-cognitive imagery rescripting.
Consolidation (2 sessions): Relapse prevention strategies are practiced before the end of intervention.
Imagery rescripting techniques (ImRs)
These techniques are developed to update imagery appraisals, by for example adding a helpful other to the image or by imagining the scene from another perspective.
Imagery intervention for voice hearing (Imagery rescripting)
The participants receive intervention for a period of 3 weeks, 6 sessions of 60 minutes.
In-depth identification of images (2 sessions): Identifying imagery which is related to the auditory vocal hallucinations, constructing a micro-formulation with the participant along the lines of regular Cognitive Behavioural Therapy. In this micro-formulation, first triggers of problematic imagery are identified, both quality and appraisals of this image are identified. Subsequent maladaptive behaviour and possible links with earlier experiences are described, as well as maintaining factors.
Imagery intervention (2 sessions): The imagery intervention consists of imagery rescripting.
Consolidation (2 sessions): Relapse prevention strategies are practiced before the end of intervention.
Promoting positive imagery de novo
These involve creating a new stand-alone positive imagery to help a client to increase his ability to self-soothe and reduce fear.
Imagery intervention for voice hearing (promoting positive imagery de novo)
The participants receive intervention for a period of 3 weeks, 6 sessions of 60 minutes.
In-depth identification of images (2 sessions): Identifying imagery which is related to the auditory vocal hallucinations, constructing a micro-formulation with the participant along the lines of regular Cognitive Behavioural Therapy. In this micro-formulation, first triggers of problematic imagery are identified, both quality and appraisals of this image are identified. Subsequent maladaptive behaviour and possible links with earlier experiences are described, as well as maintaining factors.
Imagery intervention (2 sessions): The imagery intervention consists of promoting positive imagery de novo.
Consolidation (2 sessions): Relapse prevention strategies are practiced before the end of intervention.
Visuospatial working memory tasks
These tasks are also known as imagery competing tasks (such as Tetris) and are used to directly target imagery using a tax visuospatial working memory task to reduce the frequency of intrusive imagery.
Imagery intervention for voice hearing (visuospatial working memory tasks)
The participants receive intervention for a period of 3 weeks, 6 sessions of 60 minutes.
In-depth identification of images (2 sessions): Identifying imagery which is related to the auditory vocal hallucinations, constructing a micro-formulation with the participant along the lines of regular Cognitive Behavioural Therapy. In this micro-formulation, first triggers of problematic imagery are identified, both quality and appraisals of this image are identified. Subsequent maladaptive behaviour and possible links with earlier experiences are described, as well as maintaining factors.
Imagery intervention (2 sessions): The imagery intervention consists of visuospatial working memory tasks.
Consolidation (2 sessions): Relapse prevention strategies are practiced before the end of intervention.
Interventions
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Imagery intervention for voice hearing (meta-cognitive imagery rescripting)
The participants receive intervention for a period of 3 weeks, 6 sessions of 60 minutes.
In-depth identification of images (2 sessions): Identifying imagery which is related to the auditory vocal hallucinations, constructing a micro-formulation with the participant along the lines of regular Cognitive Behavioural Therapy. In this micro-formulation, first triggers of problematic imagery are identified, both quality and appraisals of this image are identified. Subsequent maladaptive behaviour and possible links with earlier experiences are described, as well as maintaining factors.
Imagery intervention (2 sessions): The imagery intervention consists of meta-cognitive imagery rescripting.
Consolidation (2 sessions): Relapse prevention strategies are practiced before the end of intervention.
Imagery intervention for voice hearing (Imagery rescripting)
The participants receive intervention for a period of 3 weeks, 6 sessions of 60 minutes.
In-depth identification of images (2 sessions): Identifying imagery which is related to the auditory vocal hallucinations, constructing a micro-formulation with the participant along the lines of regular Cognitive Behavioural Therapy. In this micro-formulation, first triggers of problematic imagery are identified, both quality and appraisals of this image are identified. Subsequent maladaptive behaviour and possible links with earlier experiences are described, as well as maintaining factors.
Imagery intervention (2 sessions): The imagery intervention consists of imagery rescripting.
Consolidation (2 sessions): Relapse prevention strategies are practiced before the end of intervention.
Imagery intervention for voice hearing (promoting positive imagery de novo)
The participants receive intervention for a period of 3 weeks, 6 sessions of 60 minutes.
In-depth identification of images (2 sessions): Identifying imagery which is related to the auditory vocal hallucinations, constructing a micro-formulation with the participant along the lines of regular Cognitive Behavioural Therapy. In this micro-formulation, first triggers of problematic imagery are identified, both quality and appraisals of this image are identified. Subsequent maladaptive behaviour and possible links with earlier experiences are described, as well as maintaining factors.
Imagery intervention (2 sessions): The imagery intervention consists of promoting positive imagery de novo.
Consolidation (2 sessions): Relapse prevention strategies are practiced before the end of intervention.
Imagery intervention for voice hearing (visuospatial working memory tasks)
The participants receive intervention for a period of 3 weeks, 6 sessions of 60 minutes.
In-depth identification of images (2 sessions): Identifying imagery which is related to the auditory vocal hallucinations, constructing a micro-formulation with the participant along the lines of regular Cognitive Behavioural Therapy. In this micro-formulation, first triggers of problematic imagery are identified, both quality and appraisals of this image are identified. Subsequent maladaptive behaviour and possible links with earlier experiences are described, as well as maintaining factors.
Imagery intervention (2 sessions): The imagery intervention consists of visuospatial working memory tasks.
Consolidation (2 sessions): Relapse prevention strategies are practiced before the end of intervention.
Eligibility Criteria
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Inclusion Criteria
* Experiencing subclinical or clinical psychotic auditory vocal hallucinations as confirmed by a clinician and as indicated by an intensity score of 4 or more on subscale 1.3 (perceptual abnormalities) of the Comprehensive Assessment of At Risk Mental States (CAARMS) or as indicated by a score of 3 or more on item P3 (hallucinatory behavior) of the Positive and Negative Syndrome Scale (PANSS).
* A Diagnostic and Statistical Manual-5 (DSM-5; American Psychiatric Association, 2013) diagnosis in the psychosis spectrum (codes: DSM-5 codes: 297.1; 298.8; 295.40; 295.90; 295.70; 298.8; 298.9) or defined as Ultra High Risk/At Risk Mental State (ARMS or UHR) according to the CAARMS estimated by a clinician.
* Willing to complete daily monitoring throughout the duration of the study.
* Willing to be assigned to a specific imagery intervention.
* Able to attend 3 consecutive weekly session of imagery intervention and during this period 3 online check-ups.
* Able and willing to sign informed consent
Exclusion Criteria
* Acute confusional state or delirium not caused by the psychotic disorder.
* Unwillingness to participate
* Intelligence quotient (IQ) \< 70 estimated by clinician.
* Current severe substance or alcohol misuse impacting treatment (clinicians assessment).
16 Years
65 Years
ALL
No
Sponsors
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Hella Janssen
OTHER
Responsible Party
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Hella Janssen
coordinating investigator
Locations
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Geestelijke Gezondheidszorg Eindhoven (GGzE)
Eindhoven, North Brabant, Netherlands
Countries
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References
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Hales SA, Di Simplicio M, Iyadurai L, Blackwell SE, Young K, Fairburn CG, Geddes JR, Goodwin GM, Holmes EA. Imagery-Focused Cognitive Therapy (ImCT) for Mood Instability and Anxiety in a Small Sample of Patients with Bipolar Disorder: a Pilot Clinical Audit. Behav Cogn Psychother. 2018 Nov;46(6):706-725. doi: 10.1017/S1352465818000334. Epub 2018 Jul 9.
van den Berg KC, Hendrickson AT, Hales SA, Voncken M, Keijsers GPJ. Comparing the effectiveness of imagery focussed cognitive therapy to group psychoeducation for patients with bipolar disorder: A randomised trial. J Affect Disord. 2023 Jan 1;320:691-700. doi: 10.1016/j.jad.2022.09.160. Epub 2022 Oct 5.
Taylor CDJ, Bee PE, Kelly J, Emsley R, Haddock G. iMAgery focused psychological therapy for persecutory delusions in PSychosis (iMAPS): a multiple baseline experimental case series. Behav Cogn Psychother. 2020 Sep;48(5):530-545. doi: 10.1017/S1352465820000168. Epub 2020 Apr 8.
Ison R, Medoro L, Keen N, Kuipers E. The use of rescripting imagery for people with psychosis who hear voices. Behav Cogn Psychother. 2014 Mar;42(2):129-42. doi: 10.1017/S135246581300057X. Epub 2013 Aug 7.
Paulik G, Steel C, Arntz A. Imagery rescripting for the treatment of trauma in voice hearers: a case series. Behav Cogn Psychother. 2019 Nov;47(6):709-725. doi: 10.1017/S1352465819000237. Epub 2019 Apr 12.
van den Berg KC, Voncken M, Hendrickson AT, Houterman S, Keijsers GPJ. Image qualities and mood variability: Evaluating the utility of an imagery survey for bipolar disorder. J Affect Disord. 2020 Jul 1;272:77-83. doi: 10.1016/j.jad.2020.03.098. Epub 2020 Apr 29.
Other Identifiers
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NL79610.068.21
Identifier Type: -
Identifier Source: org_study_id
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