Our research

Assertive Responding to Voices: Evaulating the psychometric properties of new measures of responding to distressing voices and other people.

Several psychological therapies are currently being developed to help people respond more assertively to the distressing voices they hear. Responding assertively means to stand-up for yourself, but in a way that is respectful of the voice or person that you are talking to. There are currently no reliable questionnaires that measure assertive responding – so we cannot be sure that a therapy is helping people to develop assertive responses.

This study aims to develop two questionnaires – one that can measure assertive responding to voices, and another that can measure assertive responding to other people. We have developed initial drafts of these questionnaires with help from researchers, clinicians and other people who hear voices. For us to find out if our questionnaires are good measures, we need people who hear voices to complete them, along with some other measures.

For more information please contact Mark Hayward: mark.hayward@sussexpartnership.nhs.uk.

 

Vista is a youth mental health study looking at the social lives, relationships and activities of young people who do and do not hear voices. We are interested in better understanding what voice-hearing is like, what might make it upsetting for young people and how it might influence young people's social lives.

Many young people hear a voice or voices that other people cannot hear. Although in most cases voice-hearing will follow a transient course and can be considered part of typical development, for some young people hearing voices can be complex, persistent and be associated with numerous mental health problems later in life. Additionally, young people most at risk of long-term mental health and social disability present with social decline, in the context of non-specific symptoms. These symptoms usually include anxiety and depression and often, but not always, psychotic like experiences (e.g. hearing voices). However, we don't know much about voice-hearing in young people and how this might affect their social lives and activities. 

The goal of this study is to find out more about social relationships and activities of young people who do and do not hear voices, to find out more about voices hearing in young people and better understand when voice hearing might be upsetting for young people, and to hear about the expereinces of care / support of young people distressed by hearing voices.

Research implications will focus on informing developmentally appropriate interventions for young people, including those who hear distressing voices. 

More information 

The National Institute for Health & Care Excellence (NICE) recommend Cognitive Behaviour Therapy (CBT) as one of the best treatments for psychosis. But only 10% of people with psychosis have the chance to receive CBT. CBT is scarce because it can be quite long and needs to be delivered by highly trained therapists. We want to see if a shorter version of CBT that is delivered by therapists with less training will be helpful for people who hear voices.

The purpose of this study is to find out if a shorter version of CBT delivered by briefly trained therapists can be helpful for people who hear distressing voices. We will evaluate this form of CBT by comparing it to two control groups – one group who will receive supportive counselling and another group who will receive no additional interventions.

Findings of this study would provide helpful information and inform future research into using CBT for people who experience distressing voice hearing.

For more information please contact Kate Arnold (trail manager): Kate.Arnold2@sussexpartnership.nhs.uk.

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

1. Guided self-help cognitive-behaviour intervention for voices (GiVE): Results from a pilot randomised controlled trial

 

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.

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2. Mindfulness for voices (M4V)

 

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.

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3. Relating to voices: relating therapy for distressing auditory hallucinations (R2V)

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.

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4. Voice impact scale (VIS)

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.  This research study was to see whether this questionnaire works or not. 

 

5. Use of smartphones for coping therapy

This project is a collaboration between local researchers (Sarah Fielding-Smith and Dr Mark Hayward) and researchers at the Voices Clinic in Swinburne, Australia. The project will evaluated if smartphones could enhance the benefit of the Level 1 coping therapy. Patients were 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.

This study details how digital technologies such as EMA/I may be used in future as clinical tools to enhance therapy, and demonstrated support for the clinical utility of the integration of smartphone EMA/I with traditional face-to-face therapy for improving coping with distressing voices.

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6. Improve

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’. 

 

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