Our research

Group mindfulness-based intervention for distressing voices: A pragmatic randomised controlled trial (completed). 

Being distressed by hearing voices (‘auditory hallucinations’) is common for people diagnosed with schizophrenia. Cognitive Behaviour Therapy offered on a one to one basis is the recommended treatment, but is rarely available in practice. One solution is to offer therapy in groups so patients can receive therapy at the same time. In 2008, a pilot study (funded by Heads On, Sussex Partnership’s charity) led by Professor Paul Chadwick and Dr Mark Hayward, assessed the effectiveness of a group therapy for voices that combined mindfulness and cognitive behavioural therapy. The results suggested the therapy was beneficial. However, pilot studies often show benefits that can’t be replicated in studies with more rigorous methodologies. Consequently, the research team needed to evaluate the therapy further and successfully applied to the Department of Health’s National Institute for Health Research to fund a randomised controlled trial. 108 patients took part in this. Half of the patients received the group therapy and their usual care, and the other half received only their usual care (the control). The results indicated that the therapy can reduce the distress caused by voices, enhance mood, improve personal control and promote recovery. However, some of the findings were not maintained over the follow-up period of six months, suggesting that further work needs to be done to strengthen the benefits.

“I am delighted we can offer this innovative therapy to our patients within the Voices Clinic so soon after the conclusion of the study. We would not be able to do this without the support of many people who have helped us to develop this therapy within Sussex Partnership.” Dr Mark Hayward, Sussex Voices Clinic Director.

The Relating to Voices (R2V) study looked at the effect of relating therapy for people who experience distressing voices. Auditory hallucinations are a common and distressing experience and patients report distress reduction to be a priority. Relating therapy adopts a symptom-specific and mechanism-focused approach to the reduction of auditory hallucinations distress. Participants were randomly allocated to receive therapy or to be part of the control group.

The therapy offered 16 weeks of individual psychological therapy to help participants to relate and respond differently to their voices and other people in their social lives. The distress caused by these relationships is often maintained by the passive and/or aggressive responses of the participant. Relating therapy teaches people to relate assertively, standing-up for themselves, whilst respecting the needs of others.

Dr Mark Hayward and Dr Clara Strauss led the study and were part of the team that delivered the therapy. The study finished in 2015.

The GiVE study involved consultations with clinicians and people who hear voices to develop a brief, intervention based upon the ‘overcoming distressing voices’ self-help book. The team developed a workbook to guide participants through an eight-session intervention with opportunities to get involved in cognitive behavioural therapy-based self-help activities.

Data has been analysed and has found that GiVE is helpful in significantly reducing the distress caused by voices.

The Improve study aims to learn more about what is changing for people over the course of therapy and what isn’t in order to develop therapy techniques that more successfully target distressing voices.

Particular interest is an understanding of how therapy influences patients’ day-to-day experiences (as this is where therapy aims to make a difference). Past research has shown that mobile phone technology might be useful in capturing information about changes in people’s day-to-day experiences, such as voice hearing, negative thoughts, mood and activities, over the course of therapy. Improve will look at whether people undertaking group therapy for distressing voices within the Voices Clinic are willing and able to engage in this type of mobile phone-based research. This research will require participants to briefly record their current thoughts, feelings and activities ten times per day for three weeks, both before and after therapy, using a specially designed ‘app’. 

There are several psychological therapies that we know can be helpful for people who hear distressing voices - many of these therapies are currently on offer within the Voices Clinic.  More research is needed on the ways in which these therapies are helpful so that they can be made more readily available in the NHS.  We have ways of measuring whether these therapies help people to feel less depressed, less anxious, and feel better about themselves - but we do not have a comprehensive way of measuring the impact that voices have on people, and whether psychological therapies can improve this.  

We have developed a questionnaire, with help from researchers, clinicians, and people who hear voices themselves, that we think can accurately measure the impact of voices on the person hearing them.  The aim of this research study is to see whether this questionnaire works or not. 

To do this, we need 400 people with a psychosis diagnosis who also hear voices to complete our new questionnaire along with some others.  Completing the questionnaires takes around 15 minutes.  People can complete these questionnaires anonymously either online, over the phone or in person.  

To find out more about this research, please speak to someone from Sussex Voices Clinic voices.clinic@sussexpartnership.nhs.uk 

This project is a collaboration between local researchers (Sarah Fielding-Smith and Dr Mark Hayward) and researchers at the Voices Clinic in Melbourne, Australia. The project will evaluate if smartphones can enhance the benefit of the Level 1 coping therapy. Patients will be given a smartphone at the beginning of therapy and asked to enter data about their voice-hearing experiences when prompted by the phone. The data generated by the patient can be used in the therapy sessions to provide accurate information about the patient’s current coping strategies. The success of any adapted strategies can also be accurately captured and assessed. The project started in 2017 with 30 people to be recruited from the Voices Clinic in Sussex: 15 will receive the smartphone-assisted therapy, and 15 will be in a control group who will receive the usual coping therapy. The same numbers will be recruited in Melbourne.

Anticipated benefits

We hope the project will improve participants’ ability to self-manage their distressing voice hearing experiences. Specifically, we expect to find improvements in coping, personal empowerment and understanding of voice hearing experiences, and a reduction in the distress/negative impact associated with these experiences. Should this intervention prove feasible, acceptable, and effective, it will be further developed with the aim of future implementation within routine clinical practice across specialist clinics internationally. Finally, identifying specific factors which influence fluctuations in voices in daily life will contribute to a better understanding of voice hearing phenomena which will inform the development of more effective and targeted treatments.