Trauma‐focused imaginal exposure for auditory hallucinations: A case series

Abstract

Objective. There is mounting evidence that traumatic life events play a role in auditory hallucinations (AH). Theory suggests that some AH are decontextualized trauma memory intrusions. Exposure-based trauma-focused therapies that target trauma memory intrusions may therefore be a promising new treatment. We aimed to assess the feasibility and acceptability of a standard protocol trauma-focused imaginal exposure intervention for trauma-related AH and to provide initial proof of concept regarding potential effects on AH. Design. We conducted a single-arm case series of a six session (90 min per session) imaginal exposure intervention for trauma-related AH with assessments at baseline, posttherapy, and one-month follow-up. Results. Fifteen people were recruited and eligible to start the intervention. Participants reported high levels of satisfaction; however, temporary distress and symptom exacerbation were common and contributed to discontinuation. There was a large reduction in AH severity at one-month follow-up (adjusted d = 0.99), but individual response was highly variable. There were also large reductions in post-traumatic stress disorder symptoms and the intrusiveness of the trauma memory. Conclusions. Imaginal exposure for trauma-related AH is generally acceptable and may have large effects on AH severity for some people. However, temporary distress and symptom exacerbation are common and can lead to discontinuation. Low referral rates and uptake also suggest feasibility issues for standalone imaginal exposure for AH. The intervention may be more feasible and acceptable in the context of a broader traumafocused therapy. Well-powered trials are needed to determine efficacy and factors that impact on acceptability and therapy response. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Preliminary Effectiveness of Brief Prolonged Exposure Therapy for PTSD: Expanding Access to Effective Therapies

“…To our knowledge, this is a first attempt to investigate the preliminary effectiveness of a brief PE treatment for PTSD among adults in South Africa. The results of the intervention are consistent with similar small sample intervention studies of PE for PTSD and adds to the literature on the implementation of PE in LMIC (e.g., Brand et al, 2020;Willis et al, 2015). The brief PE treatment resulted in symptom improvement for PTSD, depression, and anxiety among adults who sought trauma-focused therapy at two community-counseling centers in South Africa.…”

Targeting dissociation using cognitive behavioural therapy in voice hearers with psychosis and a history of interpersonal trauma: A case series

“…Other recently published case series have evaluated other trauma‐focused intervention techniques, in particular imagery rescripting, that have been adapted to specifically ameliorate distressing hallucinations in people with psychosis (Brand, Bendall, Hardy, Rossell, & Thomas, 2020; Paulik, Steel, & Arntz, 2019). These case series have also uncovered promising treatment effects, comparable to those reported in our investigation.…”

‘Like jumping off a ledge into the water’: A qualitative study of trauma‐focussed imaginal exposure for hearing voices

“…Brand et al. ( 2021 ) conducted a case series of a six‐session imaginal exposure intervention for trauma‐related voices. The aim was to establish the feasibility and acceptability of delivering imaginal exposure as an intervention targeting relevant voice‐related trauma memories and to provide initial estimates of effects on voices.…”