Relating therapy for voices (the R2V study): study protocol for a pilot randomized controlled trial

Abstract

BackgroundEvidence exists for the effectiveness of cognitive behaviour therapy for psychosis with moderate effect sizes, but the evidence for cognitive behaviour therapy specifically for distressing voices is less convincing. An alternative symptom-based approach may be warranted and a body of literature has explored distressing voices from an interpersonal perspective. This literature has informed the development of relating therapy and findings from a case series suggested that this intervention was acceptable to hearers and therapists.Methods/DesignAn external pilot randomized controlled trial (RCT) comparing outcomes for 15 patients receiving 16 hours (weekly sessions of one hour) of relating therapy and their usual treatment with 15 patients receiving only their usual treatment. Participants will be assessed using questionnaires at baseline, 16 weeks (post-intervention), and 36 weeks (follow-up).DiscussionExpected outcomes will include a refined study protocol and an estimate of the effect size to inform the sample size of a definitive RCT. If evidence from a fully powered RCT suggests that relating therapy is effective, the therapy will extend the range of evidence-based psychological therapies available to people who hear distressing voices.Trial registrationCurrent Controlled Trials ISRCTN registration number 44114663. Registered on 13 June 2013.

iMAgery focused psychological therapy for persecutory delusions in PSychosis (iMAPS): a multiple baseline experimental case series

“…In terms of the change in these other brief targeted approaches, Freeman et al (2016) found using strategies to improve self-confidence a small reduction in negative schemas (Cohen's d = 0.24) and a moderate reduction in paranoia (d = 0.59). Hayward et al (2014), in a pilot randomised controlled trial of relating therapy, found a larger effect size of d = 1.30 on PSYRATS distress at end-of-therapy. Our much smaller case series would appear to compare favourably; however, larger studies need to be conducted before meaningful comparisons could be made.…”

“…As a brief targeted intervention, it could be added as a module to other theoretically based approaches, which also have initial feasibility and acceptability (Freeman et al, 2016;Hayward et al, 2014). In terms of the change in these other brief targeted approaches, Freeman et al (2016) found using strategies to improve self-confidence a small reduction in negative schemas (Cohen's d = 0.24) and a moderate reduction in paranoia (d = 0.59).…”

Brief Interventions for Psychosis

“…The approach of Birchwood and colleagues provides a bridge between early formulation-based approaches centering on intra-psychological (cognitive, affective, and behavioral) processes and a new wave of relational approaches which focus on the interpersonal relationship between the voice-hearer and the voice Hayward et al 2014 ;. Relating therapy (Hayward et al 2009 ) specifi cally applies Birtchnell's ( 1996 ) interpersonal model to the voice-hearer relationship, identifying key interpersonal dimensions of power and proximity (Birtchnell 1996 ).…”

Targeting Recovery in Persistent Persecutory Delusions: A Proof of Principle Study of a New Translational Psychological Treatment (the Feeling Safe Programme)

“…The use of a modular approach in the Feeling Safe Programme is helpful in its flexibility, allowing for the later addition of other theoretically underpinned approaches that may emerge as clinically useful (e.g. Hayward, Strauss and Bogen-Johnston, 2014 ; van den Berg et al, 2015 ; Lincoln, Hartmann, Kӧther and Moritz, 2015 ; Morrison et al, 2014 ). The baseline scores of a number of the trial patients reduced slightly over time – one interpretation is that the delusions were already beginning to recover, but our view, given the previous persistence of the delusions, is that this reflects the early stages of change triggered by the frequent and relevant assessments.…”