1. Click to edit Master subtitle style Group Person-Based Cognitive Therapy for distressing voices: Views from the hearers Dr Mark Hayward Director of Research SPR Conference 25th March 2010

2. Learning with….  Luke Goodliffe – University of Surrey  Dora Brown – University of Surrey  Laura Dannahy – Hampshire Partnership NHS Foundation Trust  Wendy Turton – University of Southampton  Paul Chadwick – Institute of Psychiatry

3. Another ‘wave’?  Group CBT for voices/psychosis not fulfilling early promise  Elaborate emerging relational understandings  Incorporate acceptance and mindfulness-based approaches

4. PBCT (Chadwick, 2006) 4 domains of proximal developme nt Relationship to internal experience Symbolic self Schemata Symptomatic meaning Radical collaboration

5. Group PBCT  Sessions 1 & 2 – exploration of three key themes: when the voices first began; participants’ own ideas about voices; and the impact of voices.  Session 3 – introduction of cognitive model, emphasising influential role of beliefs about voices (Chadwick & Birchwood, 1997)  Sessions 4-7 – elaboration of beliefs within a relational framework, highlighting beliefs about self. Use of mindfulness exercises to facilitate acceptance of voice hearing experiences (Chadwick et al, 2005)  Session 8 – reflections upon learning and maintenance of changed relationships

6. Participants  N=30 (21 women & 9 men)  Mean age = 41 years  Duration of voices = 13.2 years  PSYRATS mean scores: - amount of negative content = 3.8 - intensity of distress = 3.2 - controllability of voices = 3.5  BAVQ-R mean scores: - malevolence (0-18) = 13.1 - omnipotence (0-18) = 13.5 - resistance (0-24) = 21.6

7. Significant findings (N = 21) Control attributed to voice (0-100) 2 v 3 2 v 4 Distress (0-4) 2 v 3 2 v 4 Social Functioning (0-4) 1 v 4 2 v 4

8. Methodology  N=18 – five focus groups  Research question: how do hearers experience group-based PBCT for voices, with reference to expectations, therapeutic process and change?  Data analysed using Grounded Theory (Charmaz, 2003)

9. Preliminary theory Sharing Negative Characteristics of Voices Developing a Group Identity Learning to Cope with Voices Development of Sense-of- Self beyond voices

10. Learning to cope with voices  Altered expectations “I wasn’t expecting to cope with the voices still there. I wasn’t expecting to, just be in control. I was expecting to either have the voice or not have the voice”  Acceptance and understanding “I was bitterly, bitterly resentful towards myself, that this illness had come into my life. And now I’m learning to accept this. I’m quite a lot happier in myself now that I’ve accepted it.”

11. Learning to cope with voices  Reflecting on the power of voices “I learnt that […] it was still my will that overcame the voice that was extremely powerful. I was still more powerful than the voice at the end of the day…”  Increased use of coping strategies “You’re trying not to do what they’re telling you to do. That’s why the group has been so good, because there is a bit of […] ‘this is what you can try, or you can do’, whereas before you’re on your own”

12. Development of sense-of-self beyond voices  Re-evaluating the concept of illness “It’s just one of those things that we’ve got with our illness, you know. And it can be overcome. It’s just learning different strategies to change things around”  Separating voices from identity “I found it very hard to understand why I couldn’t stop [the voices] if it was me doing them. And the group’s helped me understand that yes, it is me, but also it’s not really me, it’s my mind”

13. Development of sense-of-self beyond voices  Re-evaluating perspectives of the self “ It wasn’t until we were in the group that we started to realise that you hadn’t done anything bad. You know? But all of them were saying ‘Yeah, well I must have done something bad to make me have these voices’ […]. We can’t all be evil. We can’t all be wrong. “You learn new things about yourself. That you’ve got resources and assets to call on to help you deal with your illness. I never thought I was going to be working on something that I’ve already got”

14. Mapping the change  From cure to acceptance of self and voices  exploration of voice’s power, intent, etc. (symptomatic meaning)  creating space between self and voice(s) (relationship to internal experience)  Voices as one aspect of self  separating from voices and strengthening positive views of self (schemata)

15. Additive insights mevoiceothers Personal responsibility ‘coper ’

16. Further questions  The role of mindfulness?  The influence of ‘relationship’?  Scope to promote ‘symbolic self’?

17. Next steps  Extend length of therapy - findings corroborated over 12 session protocol - qualitative exploration of sense of self  External funding for an RCT  Use of group PBCT for other ‘treatment resistant conditions’

18. Key references Abba, N., Chadwick, P. & Stevenson, C. (2008). Responding mindfully to distressing psychosis: A grounded theory analysis. Psychotherapy Research, 18, 77-87. Chadwick, P. (2006). Person-Based Cognitive Therapy for Distressing Psychosis. Chichester: Wiley. Goodliffe, L., Hayward, M., Brown, D., Turton, W. & Dannahy, L. (in press). Group Person-Based Cognitive Therapy for distressing voices: Views from the hearers. Psychotherapy Research. Hayward, M., Denney, J., Vaughan, S. and Fowler, D. (2008). The Voice and You (VAY): A person’s assessment of the relationship they have with their predominant voice. Clinical Psychology & Psychotherapy, 15, 45- 52.