Imagery Interventions for Auditory Vocal Hallucinations

Hella Janssen

Status: Completed

Conditions: Hearing Voices When No One is Talking; Psychosis; Auditory Hallucination

Treatments: Behavioral: Imagery intervention for voice hearing (visuospatial working memory tasks); Behavioral: Imagery intervention for voice hearing (promoting positive imagery de novo); Behavioral: Imagery intervention for voice hearing (Imagery rescripting); Behavioral: Imagery intervention for voice hearing (meta-cognitive imagery rescripting)

Study type: Interventional

Funder types: Other

Identifiers

NCT05603260

NL79610.068.21

Details and patient eligibility

About

This study explores the feasibility, acceptability, and effectiveness of four imagery intervention techniques (metacognitive imagery intervention, imagery rescripting, promoting positive imagery and competing imagery task) for auditory vocal hallucinations using four single case series with an A-B-A within subject design.

Full description

Auditory vocal hallucinations (AVHs) are the most common hallucinations of psychosis and do often occur in several other mental disorders. The effects of current standard psychological therapy (cognitive behavioural therapy; CBT) for auditory vocal hallucinations are limited. Thus, there is a need to improve cognitive behavioural therapy for auditory vocal hallucinations. As for many other mental disorders specific treatments have been improved using interventions targeting mental imagery, and recent studies pointed towards an association between psychotic symptoms and mental imagery, adding imagery intervention to CBT might aid this aim.

The main objective of this study is to assess the feasibility, acceptability, and effectiveness of four imagery intervention techniques (metacognitive imagery intervention, imagery rescripting, promoting positive imagery and competing imagery task) for auditory vocal hallucinations. The investigators are primarily interested in whether these imagery intervention techniques would be associated with a decrease in auditory vocal hallucinations and imagery symptoms. Also, the investigators are interested in whether these imagery intervention techniques would be a feasible and acceptable intervention for patients with a disorder in the transdiagnostic psychosis and suffering from auditory hallucinations. Secondly, the investigators aim to assess the effects on the level of delusions, visual hallucinations and social and occupational functioning. Lastly, the investigators aim to explore the working mechanisms of imagery, affective symptomatology, and auditory vocal hallucinations by three times daily measuring these symptoms for a period of seven weeks.

The investigators hypothesise that 1) all four imagery interventions are associated with a significant decrease in AVHs (e.g., a decline in the level of auditory vocal hallucinations) and imagery characteristics (e.g., decline in imagery frequency, imagery appraisals and imagery quality), whereas no serious adverse side-effects would occur, drop-out rates of therapy are low and patients will give a good qualitative review of therapy. 2) Psychotic symptoms decrease and social and occupational functioning increase after treatment. 3) The severity of emotional imagery is positively associated with the severity AVHs. In addition, the investigators hypothesize that this association may be different for different imagery aspects, with stronger associations between imagery appraisals (i.e., the encapsulated beliefs, and metacognitive beliefs) and the severity of AVHs as compared to other imagery aspects (frequency and quality aspects). And 4) The associations between imagery related factors and the severity of AVHs are mediated by the level of symptoms of anxiety and depression.

The primary outcome variables, the level of auditory vocal hallucinations and imagery characteristics, are calculated using daily measurements during a two-week baseline, during the intervention and after the end of intervention at follow-up at 7 weeks. Most secondary outcome variables are assessed using self-report measures before baseline, and at pre- and post-intervention.

Enrollment: 32 patients

Sex: All

Ages: 16 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age 16-65
• Experiencing subclinical or clinical psychotic auditory vocal hallucinations as confirmed by a clinician and as indicated by an intensity score of 4 or more on subscale 1.3 (perceptual abnormalities) of the Comprehensive Assessment of At Risk Mental States (CAARMS) or as indicated by a score of 3 or more on item P3 (hallucinatory behavior) of the Positive and Negative Syndrome Scale (PANSS).
• A Diagnostic and Statistical Manual-5 (DSM-5; American Psychiatric Association, 2013) diagnosis in the psychosis spectrum (codes: DSM-5 codes: 297.1; 298.8; 295.40; 295.90; 295.70; 298.8; 298.9) or defined as Ultra High Risk/At Risk Mental State (ARMS or UHR) according to the CAARMS estimated by a clinician.
• Willing to complete daily monitoring throughout the duration of the study.
• Willing to be assigned to a specific imagery intervention.
• Able to attend 3 consecutive weekly session of imagery intervention and during this period 3 online check-ups.
• Able and willing to sign informed consent

Exclusion criteria

• Any current or previous neurological disorder or organic brain disease.
• Acute confusional state or delirium not caused by the psychotic disorder.
• Unwillingness to participate
• Intelligence quotient (IQ) < 70 estimated by clinician.
• Current severe substance or alcohol misuse impacting treatment (clinicians assessment).

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

---

32 participants in 4 patient groups

Meta-cognitive imagery rescripting techniques (M-Int)

Other group

Description:

These techniques are developed to reduce the power of an image by changing how the client responds to an image by shifting attention away from it, or by doing something that reinforces that it is just an image and not "real".

Treatment:

Behavioral: Imagery intervention for voice hearing (meta-cognitive imagery rescripting)

Imagery rescripting techniques (ImRs)

Other group

Description:

These techniques are developed to update imagery appraisals, by for example adding a helpful other to the image or by imagining the scene from another perspective.

Treatment:

Behavioral: Imagery intervention for voice hearing (Imagery rescripting)

Promoting positive imagery de novo

Other group

Description:

These involve creating a new stand-alone positive imagery to help a client to increase his ability to self-soothe and reduce fear.

Treatment:

Behavioral: Imagery intervention for voice hearing (promoting positive imagery de novo)

Visuospatial working memory tasks

Other group

Description:

These tasks are also known as imagery competing tasks (such as Tetris) and are used to directly target imagery using a tax visuospatial working memory task to reduce the frequency of intrusive imagery.

Treatment:

Behavioral: Imagery intervention for voice hearing (visuospatial working memory tasks)