A multicentre, randomised controlled trial of cognitive therapy to reduce harmful compliance with command hallucinations
Lead Research Organisation:
University of Birmingham
Department Name: School of Psychology
Abstract
Schizophrenia remains the most debilitating of the psychiatric disorders; and in spite of advances in drug treatment, over 50% of people with schizophrenia continue to experience distressing symptoms, including command hallucinations (CHs),60% of which stipulate harmful or dangerous actions. Most patients try to resist these commands but feel compelled to obey, fearing the consequences if they don t. Such individuals are of great concern to clinicians and consume exceptionally high levels of services. There are no accepted treatment for this high risk group.We recently completed a pilot trial funded by the DoH of an adapted form of cognitive therapy(a talking therapy) which sucessfuly reduced compliance with the voice by encouraging the patient to see that the voice is not as powerful as they believe. In this proposed trial we compare the treatment with treatment as usual in 3 centres in the UK , using the infrastructure of the Mental Health Research Network. Over a period of 18 months we will recruit 180 individuals;our primary aim is to reduce compliance and self harm which will be monitored over 18 months.NHS and other service consumption will also be monitored .
This study will provide a breakthrough , evidence based treatment for this high-need group and open the way for further important work to help similar patients.The applicant has considerable experience of public dissemination of results of this kind of research through radio and TV interviews. He is also patron to RETHINK a leading UK mental health charity that actively promotes this therapy to their members and families.
This study will provide a breakthrough , evidence based treatment for this high-need group and open the way for further important work to help similar patients.The applicant has considerable experience of public dissemination of results of this kind of research through radio and TV interviews. He is also patron to RETHINK a leading UK mental health charity that actively promotes this therapy to their members and families.
Technical Summary
In spite of advances in drug treatment, over 50% of people with schizophrenia continue to experience distressing psychotic symptoms;the most distressing, high-risk, yet treatment resistant, are command hallucinations(CHs). Harmful compliance with, or appeasement of CHs is evident in about 60% of those with commands that stipulate harmful or dangerous actions. Such individuals are of great concern to clinicians and consume exceptionally high levels of services. There are no evidence based treatments for this high risk group.Following phase I and II work we recently reported our DoH funded pilot trial of adapted cognitive therapy for CHs(CTCH). CTCH promises a treatment effect of major clinical significance, substantially reducing harmful compliance(effect size=1.2). In this proposed pragmatic trial we compare CTCH with treatment as usual(TAU) in 3 centres in the UK , using the infrastructure of the Mental Health Research Network. Over an inception period of 18 months we will recruit 180 individuals;our primary outcome will be compliance and self harm which will be monitored over a further 18 months.Service consumption will also be monitored .The main process measure will be patients appraisal of voices power, the main target of CTCH. This study will provide breakthrough, evidence based treatment for this high-risk group and open the way for further important work to help similar high risk groups to live in the community.
Publications

Paulik G
(2013)
Cognitive Behavioural Relating Therapy (CBRT) for voice hearers: a case study.
in Behavioural and cognitive psychotherapy

Birchwood M
(2011)
A multi-centre, randomised controlled trial of cognitive therapy to prevent harmful compliance with command hallucinations.
in BMC psychiatry


Cella M
(2019)
Blending active and passive digital technology methods to improve symptom monitoring in early psychosis.
in Early intervention in psychiatry

Wykes T
(2014)
Cognitive-behaviour therapy and schizophrenia.
in Evidence-based mental health

Griffiths S
(2012)
Cognitive Theory and Therapy for Command Hallucinations
in Journal of Experimental Psychopathology

Birchwood Max
(2014)
Cognitive behaviour therapy to prevent harmful compliance with command hallucinations (COMMAND): a randomised controlled trial
in LANCET PSYCHIATRY

Birchwood M
(2018)
The COMMAND trial of cognitive therapy to prevent harmful compliance with command hallucinations: predictors of outcome and mediators of change.
in Psychological medicine

Ruddle A
(2014)
A case series exploring possible predictors and mechanisms of change in hearing voices groups.
in Psychology and psychotherapy

Bucci S
(2013)
Predicting compliance with command hallucinations: anger, impulsivity and appraisals of voices' power and intent.
in Schizophrenia research
Title | Cognitive behavioural therapy for Command hallucinations |
Description | A cognitive-behavioural therapy for command hallucinations is currently being evaluated in a large scale randomized controlled trial |
Type | Therapeutic Intervention - Complementary |
Current Stage Of Development | Late clinical evaluation |
Year Development Stage Completed | 2006 |
Development Status | Under active development/distribution |
Impact | A pilot study has already proven the effectiveness of this therapy in reducing risk in people with command hallucinations. The long term effect of this intervention is currently being tested within a large scale RCT |
Description | European Congress of Psychiatry. Madrid |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | 100 plus professional |
Year(s) Of Engagement Activity | 2016 |
Description | Presentation: Mental Health Innovation workshop - Hokkaido, Japan |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Presentation: "Does CBT for psychosis have a future?" |
Year(s) Of Engagement Activity | 2018 |
Description | Two Presentations in:1) Quebec University and Mental Health Services, Canada; 2.) Montreal CHUM |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Two talks on: "The COMMAND trial of cognitive therapy for harmful compliance with command hallucinations: the therapy, trial outcome and predictors /mediators of change." |
Year(s) Of Engagement Activity | 2017 |
Description | York University |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Professional Practitioners |
Results and Impact | A lecture on Psychological treatments |
Year(s) Of Engagement Activity | 2018 |
Description | community mental health teams & inpatient wards - Birmingham, Manchester and London |
Form Of Engagement Activity | A formal working group, expert panel or dialogue |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Health professionals |
Results and Impact | presentations have been and are still conducted in community mental health team during multidisciplinary meetings which health professionals attend (CPNs, psychiatrists, psychologists, social workers). Each of these meetings is attended by all the members of each clinical team. The presentations are conducted jointly by the trial manager and research associate. There meetings have promoted recruitment to the trial, generated referrals and have served the purpose of advertising the trial and building relationshiops with community mental health teams and clinicians |
Year(s) Of Engagement Activity | 2007,2008,2009 |