Setting up, running and evaluating a

CBT Hearing Voices Group

Dr Anna Ruddle & Dr Steven Livingstone (Clinical Psychologists)Psychosis Clinical Academic Group (CAG)

South London and Maudsley NHS Trust

ISPS UK Conference 2nd & 3rd October 2012

Psychosis Clinical Academic Group (CAG)

Overview

• Background Context

• Benefits of CBT Hearing Voices Groups

• Group Description and Roleplay

• Setting up the Group

• Recruitment and Assessment

• Evaluating the Group

• Overcoming Obstacles and Roleplay

Psychosis Clinical Academic Group (CAG)

• What experience do you have of working with people who hear voices?

• What experience do you have of running groups?

• What made you choose this workshop?

Workshop Task

Psychosis Clinical Academic Group (CAG)

• First groups via Hearing Voices Network, late 1980s

• Network principles

• Current Hearing Voices Network groups

• NHS HVGs – increasing popularity

• CBT groups

Background to HVGs

Psychosis Clinical Academic Group (CAG)

• Evidence base – Ruddle et al., 2011

• Increasing access to CBT (NICE recommended)

• Normalising a stigmatised experience

• Safe space to try new beliefs and behaviours

• Decreasing social isolation

Benefits of CBT HVGs

Psychosis Clinical Academic Group (CAG)

• 7-sessions, weekly, 1hr-1hr15mins• Closed group• 6-8 ideal; bear in mind drop-out• Facilitators x2; past experience• Manualised; balance of structure/open

discussion• Group aims – reduce distress, possibly by

enhancing coping and challenging negative beliefs about voices

The group

Psychosis Clinical Academic Group (CAG)

Adapted from Wykes et al.’s (1999) manual:• Session 1 – Sharing information about voices• Session 2 – Explanations of voices• Session 3 – Coping strategies• Session 4 – Beliefs about voices• Session 5 – Stigma and discrimination• Session 6 – Self-esteem• Session 7 – Overall model of voices

CBT HVG Manual

Psychosis Clinical Academic Group (CAG)

• Usually community-based teams

• Other settings/client-groups possible

• Evidence based on clients with a schizophrenia-spectrum diagnosis

• Clients who currently report hearing voices that cause distress and/or limit their functioning

Service setting and client group

Psychosis Clinical Academic Group (CAG)

• Plan in advance

• Practicalities – room; budget (refreshments, stationery, flipchart, name labels etc); DVD player; kettle, mugs etc

• Time commitment

Setting up the group

Psychosis Clinical Academic Group (CAG)

• Recruit from within your team

• Rolling recruitment

• Posters and leaflets

• Encourage over-inclusiveness

• Team meetings

• Discuss each CC caseload

• It can be very hard!!

Recruitment Suggestions

Psychosis Clinical Academic Group (CAG)

• Recommend individual assessments

• Facilitator/s to conduct

• Service user co-conduct

• Aims: engage; normalise; offer information; reassurance; assist informed decision; check suitability; do outcomes

• 30 mins approx

• Incorporate into asst for 1:1 therapy

Assessment Suggestions

Psychosis Clinical Academic Group (CAG)

Evaluation

Based on our experience:

• CORE-OM (self-report questionnaire)

• PSYRATS (semi-structured interview)

• 2 self-identified goals for the group (VAS scale 0-10) – see CHOICE

• Qualitative feedback (semi-structured interview)

Psychosis Clinical Academic Group (CAG)

• What obstacles could people envisage arising in the setting up, running or evaluation of the group?

Obstacles?

Psychosis Clinical Academic Group (CAG)

Roleplay an Obstacle

Questions?

• If you decide to run the group in your local service, please do not hesitate to contact us with any queries.

Psychosis Clinical Academic Group (CAG)

Key References• Romme, M. & Escher, S. (1993). Accepting voices. Dorset, UK:

Blackmore Press - Sets out the normalising approach used by the Hearing Voices Network, alternative ways of understanding voices, and interesting first hand accounts from voice-hearers.

• Ruddle, A., Mason, O., & Wykes, T. (2011). A Review of Hearing Voices Groups: Evidence and Mechanisms of Change. Clinical Psychology Review, 31, 757-766. – Overview of different HVG approaches and their evidence-base.

• Wykes, T., Parr, A., & Landau, S. (1999). Group treatment of auditory hallucinations: Exploratory study of effectiveness. British Journal of Psychiatry, 175, 180-85. – Developed the original CBT manual we have now adapted.