A multicentre, randomised controlled trial of cognitive therapy to reduce harmful compliance with command hallucinations

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.

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.