BACKGROUND: Medication-resistant, persistent auditory hallucinations are pervasive in persons with schizophrenia. Behavior strategies are often very effective as adjunctive therapy to decrease the negative characteristics of this symptom.
OBJECTIVES: The purpose of this multi-site intervention study was to examine the short-term effects of a 10-week course to teach behavior management of persistent auditory hallucinations on seven characteristics of auditory hallucinations (i.e., frequency, loudness, self-control, clarity, tone, distractibility, and distress), anxiety, and depression.
STUDY DESIGN: A quasi-experimental repeated measured design was used. The sample included 62 outpatients with schizophrenia who reported daily persistent auditory hallucinations. Measures included the Characteristics of Auditory Hallucinations Questionnaire, the tension-anxiety subscale of the Profile of Mood States, and the Beck Depression Inventory II.
RESULTS: Preintervention scores for the frequency (p < .001), self-control (p < .03), clarity (p < .01), tone (p < .03), distractibility (p < .006), and distress (p < .001) improved compared with preintervention scores. Postintervention scores on anxiety and depression were also significantly lower than preintervention scores (p < .02, p < .001, respectively).
CONCLUSIONS: Teaching behavior management of persistent auditory hallucinations in a standardized 10-week course is clinically effective and can be incorporated into many existing outpatient programs.
Get full access to this article
View all access options for this article.
References
1.
Allen, H.A., Halperin, J., & Friend, R. (1985). Removal and diversion tactics and the control of auditory hallucinations. Behaviour Research and Therapy, 23, 601-605.
2.
Alford, G.S., & Turner, S.M. (1976). Stimulus interference and conditioned inhibition of auditory hallucinations. Journal of Behavior Therapy and Experimental Psychiatry, 7, 155-160.
3.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
4.
American Psychiatric Association (APA). (1997). Practice guidelines for the treatment of patients with schizophrenia. American Journal of Psychiatry, 154(4) (Suppl.), 1-63.
Bentall, R.P., Haddock, G., & Slade, P.D. (1994). Cognitive behavior therapy for persistent auditory hallucinations: From theory to therapy. Behavior Therapy, 25, 51-66.
7.
Betempts, E.J., & Ragiel, C. (1994). Psychiatric epidemiology: Facts and myths on mental health and illness. Journal of Psychosocial Nursing, 32(5), 23-27.
8.
Breier, A., & Strauss, J.S. (1983). Self-control in psychotic disorders. Archives of General Psychiatry, 40, 1141-1145.
9.
Buccheri, R.K., Trygstad, L., Kanas, N., & Dowling, G.A. (1997). Symptom management of auditory hallucinations in schizophrenia: Results of one year follow-up. Journal of Psychosocial Nursing and Mental Health Services, 35(12), 20-28.
10.
Buccheri, R.K., Trygstad, L., Kanas, N., Waldron, B., & Dowling, G.A. (1996). Auditory hallucinations in schizophrenia: Group experience in examining symptom management and behavior strategies. Journal of Psychosocial Nursing and Mental Health Services, 34(2), 12-25.
11.
Carr, V. (1988). Patients’ techniques for coping with schizophrenia: An exploratory study. British Journal of Medical Psychology, 61, 339-352.
12.
Carter, D.M., Mackinnon, A., & Copolov, D.L. (1996). Patients’ strategies for coping with auditory hallucinations. Journal of Nervous and Mental Disease, 184, 159-164.
13.
Chadwick, P., & Birchwood, M. (1994). The omnipotence of voices: A cognitive approach to auditory hallucinations. British Journal of Psychiatry, 164. 190-201.
14.
Collins, M.N., Cull, C.A., & Sireling, L. (1989). Pilot study of treatment of persistent auditory hallucinations by modified auditory input. British Medical Journal, 12, 431-432.
15.
Conwell, Y., Cholette, J., & Duberstein, P.R. (1998). Suicide and schizophrenia: Identifying risk factors and preventive strategies. Medscape: Psychiatry & Mental Health, 3. Retrieved August 15, 1999 from http//psychiatry.medscape.com
16.
Corrigan, P.W., & Storzbach, D.M. (1993). Behavioral interventions for alleviating psychotic symptoms. Hospital and Community Psychiatry, 44, 341-347.
17.
Done, D.J., Frith, C.D., & Owens, D.C. (1986). Reducing persistent auditory hallucinations by wearing an ear-plug. British Journal of Clinical Psychology, 25, 151-152.
18.
Falloon, I.R.H., & Talbot, R.E. (1981). Persistent auditory hallucinations: Coping mechanisms and implications for management. Psychological Medicine, 11, 329-339.
19.
Feder, R. (1982). Auditory hallucinations treated by radio head-phones. American Journal of Psychiatry, 139, 1188-1190.
20.
Fenton, W.S., McGlashan, T.H., Victor, B.J., & Blyler, C.R. (1997). Symptoms, subtype and suicidality in patients with schizophrenia spectrum disorders. American Journal of Psychiatry, 154, 199-204.
Folstein, M.F., Folstein, S.E., & McHugh, P.R. (1975). Mini-mental state: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189-198.
23.
Frederick, J., & Cotanch, P. (1995). Self-help techniques for auditory hallucinations in schizophrenia. Issues in Mental Health Nursing, 16, 213-224.
24.
Frederick, J.A., & Killeen, M.R. (1998). Instruments of assessment of auditory hallucinations. Archives of Psychiatric Nursing, 12, 255-263.
25.
Haddock, G., Bentall, R.P., & Slade, P.D. (1993). Psychological treatment of chronic auditory hallucinations: Two case studies. Behavioral and Cognitive Psychotherapy, 21, 335-346.
26.
Hustig, H.H., & Hafner, R.J. (1990). Persistent auditory hallucinations and their relationship to delusions and mood. Journal of Nervous and Mental Disease, 178, 264-267.
27.
Hustig, H.H., Tran, D.B., Hafner, R.J., & Miller, R.J. (1990). The effect of headphone music on persistent auditory hallucinations. Behavioural Psychotherapy, 18, 273-281.
28.
Jenner, J.A.van de Willige, G., & Wiersma, D. (1998). Effectiveness of cognitive therapy with coping training for persistent auditory hallucinations: A retrospective study of attenders of a psychiatric out-patient department. Acta Psychiatrica Scandinavica, 98, 384-389.
29.
Kanfer, F.H. (1971). The maintenance of behavior by self-generated stimuli and reinforcement. In A. Jacobs & L.B. Sachs (Eds.), The psychology of private events: Perspectives on covert response systems (pp. 38-59). New York: Academic Press.
30.
Kanas, N. (1996). Group therapy for schizophrenic patients. Washington, DC: American Psychiatric Press.
31.
Kendler, K.S., Gallagher, T.J., Abelson, J.M., & Kessler, R. (1996). Lifetime prevalence, demographic risk factors, and diagnostic validity of nonaffective psychosis as assessed in a US community sample—the national comorbidity survey. Archives of General Psychiatry, 53, 1022-1031.
Margo, A., Hemsley, D.R., & Slade, P.D. (1981). The effects of varying auditory input on schizophrenic hallucinations. British Journal of Psychiatry, 139, 122-127.
34.
McNair, D.M., Lorr, M., & Droppleman, L.F. (1992). Edits manual for the Profile of Mood States. San Diego, CA: EDITS/Educational and Industrial Testing Service.
35.
Miller, L.H. (1996). Qualitative changes in hallucinations. American Journal of Psychiatry, 153, 265-267.
36.
Nelson, H.E., Thrasher, S., & Barnes, T.R. (1991). Practical ways of alleviating auditory hallucinations. British Medical Journal, 302, 327.
37.
O’Sullivan, K. (1994). Dimensions of coping with auditory hallucinations. Journal of Mental Health, 3, 351-361.
Rutner, I.T., & Bugle, C. (1969). An experimental procedure for the modification of psychotic behavior. Journal of Consulting and Clinical Psychology, 33, 651-653.
40.
Shergill, S.S., Murray, R.N., & McGuire, P.K. (1998). Auditory hallucinations: A review of psychological treatment. Schizophrenia Research, 32, 137-150.
41.
Slade, P.A. (1972). Case histories and shorter communications: The effects of systematic desensitisation on auditory hallucinations. Behaviour Research and Therapy, 10, 85-91.
42.
Slade, P.A. (1974). The external control of auditory hallucinations: An information theory analysis. British Journal of Social and Clinical Psychology, 12, 73-79.
43.
Tarrier, N. (1987). An investigation of residual psychotic symptoms in discharged schizophrenic patients. British Journal of Clinical Psychology, 26, 141-143.
44.
Turner, S.M., Hersen, M., & Bellack, A.S. (1977). Effects of social disruption, stimulus interference, and aversive conditioning on auditory hallucinations. Behavior Modification, 1, 249-259.
45.
UCSF Symptom Management Faculty Group. (1995). A model for symptom management. Image: The Journal of Nursing Scholarship, 26, 272-276.
46.
Yalom, I.D. (1985). The theory and practice of group psychotherapy (3rd ed.). New York: Basic Books.
