Command hallucinations (CH) are a distressing and high-risk group of symptoms that have long been recognised but little understood, with few effective treatments. In this paper we report and discuss the efficacy of cognitive therapy (CT) modified in accordance with ‘social rank theory,’ in a single blind randomised controlled trial. 38 patients with command hallucinations were randomly allocated to CT or treatment as usual and followed up for 6 then 12 months. Large reductions in compliance behaviour were obtained (effect size = 0.97) favouring the CT group. Other significant differences were found and maintained at 6 months follow up.
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References
Applebaum, P. S., Robbins, P., & Monahan, J. (2000). Violence and delusions: data from the MacArthur violence risk assessment. American Journal of Psychiatry, 157, 566–572.
Beck, A. T. (1952). Successful outpatient psychotherapy of a chronic schizophrenic with a delusion based on borrowed guilt. Psychiatry: Journal for the Study of Interpersonal Processes, 305–312.
Birchwood, M., Iqbal, Z., Jackson, C., & Hardy, K. (2004). Cognitive therapy and emotional dysfunction in early psychosis in Psychological Interventions in Early Psychosis: A Treatment Handbook. In Gleeson, F. M., & P. D. McGorry (Eds.), Chichester: Wiley.
Birchwood, M., & Chadwick, P. (1997). The omnipotence of voices: Testing the validity of a cognitive model. Psychological Medicine, 27, 1345–1353.
Braham, L. G., Trower, P., & Birchwood, M. (2004). Acting on command hallucinations and dangerous behaviour: A critique of the major findings in the last decade. Clin Psychol Rev, 24(5), 513–528.
Brennan, P., Mednick, S., & Hodges, S. (2000). Major mental disorders and criminal violence in a Danish birth cohort. Archives of General psychiatry, 57, 494–500.
Brett-Jones, J., Garety, P., & Hemsley, D. R. (1987). Measuring delusional experiences: A method and its application. British Journal of Clinical psychology, 26, 257– 265.
Buchanon, A., Reed, A., Wessely, S., Garety, P., Taylor, P. Grubin, D., et al. (1993). Acting on delusions II: The phenomenological correlates of acting on delusions. British Journal of Psychiatry, 163, 77–81.
Chadwick, P. D., Birchwood, M., & Trower, P. (1996). Cognitive Therapy for Delusions, Voices and Paranoia. Chichester. John Wiley and Sons.
Chadwick, P. D. J., & Birchwood, M. (1994). The omnipotence of voices: A cognitive approach to auditory hallucinations. British Journal of Psychiatry, 164, 190–201.
Chadwick, P. D. J., & Lowe, C. F. (1990). Measurement and modification of delusional beliefs. Journal of Consulting and Clinical Psychology, 58, 225–232.
Cormac, I., Jones, C., & Campbell, C. (2002). Cognitive behaviour therapy for schizophrenia. Cochrane Library. Issue 3. Oxford: Update Software.
Department of Health. Mental Health Act (1983).
Drury, V., Birchwood, M., Cochrane, R., & Macmillan, F. (1996b). Cognitive therapy and recovery from acute psychosis: A controlled trial II: Impact on recovery. British Journal of Psychiatry, 169, 602–607.
Durham, R. C., Gurthrie, M., Morton, R. V., et al. (2003). Tayside — Fife clinical trial of cognitive behavioural therapy for medication resistant psychotic symptoms. British Journal of Psychiatry, 182, 303–311.
Gould, R. A., Mueser, K. T., Bolton, E., Mays, V., & Goff, D. (2001). Cognitive therapy for psychosis in schizophrenia, an effect size analysis. Schizophrenia Research, 24, 335–342.
Haddock, G., McCarron, J., & Tarrier, N. (1999). Scales to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS). Psychological Medicine, 39, 879–889.
Kuipers, E., Fowler, D., Garety, P., Chisholm, D., Freeman, D., Dunn, et al. (1998). London-East Anglia randomised controlled trial of cognitively behavioural therapy for psychosis III: follow-up and economic evaluation at 18 months. British Journal of Psychiatry, 171, 319–327.
Maden, A., Scott, F., Burnett, R., Lewis, G. H., & Skapinakis, P. (2003). Offending in psychiatric patients after discharge from medium secure units: Prospective national cohort study. BMJ, 2004 Jun 26; 328(7455), 1534.
McGorry, P. D., Yung, A. R., Phillips, L. J., Yuen, H. P., Francey, S., Cosgrave, E., et al. (2002). Randomised con trolled trial of interventions designed to reduce the risk of progression to first episode psychosis in a clinical sample with subthreshold symptoms. Archives of General Psychiatry, 59, 921–928.
Milton, J., Amin, S., Sin, hS., Harrison, G., Jones, P., Croudace, T., et al. (2001). Aggressive incidents in first episode psychosis. 178, 433–440.
Pilling, S., Bebbington, P., Kuipers, E., Garety, P., Geddes, J., Orbach, G., et al. (2002). Psychological treatments in schizophrenia: I Meta-analysis of family intervention and cognitive behaviour therapy. Psychological Medicine, 32, 763–782.
Rudnick-Abraham, S. (1999). Relation between command hallucinations and dangerous behaviour. Journal of the American Academy of Psychiatry and Law, 27, 253–257.
Sensky, T., Turkington, D., Kingdon, D., Scott, J. L., Siddle, R., O’Carroll, M., et al. (2000). A randomised controlled trial of cognitive behavioural therapy for persistent symptoms in schizophrenia resistant to medication. Archives of General Psychiatry, 57, 165–172.
Shawyer, F., Mackinnon, A., & Farhall, J. et al. (2003). Command hallucinations and violence: Implications for detention and treatment. Psychiatry, Psychology and Law, 10, 97–107.
Tarrier, N., & Wykes, T. (2004). Is there evidence that cognitive behaviour therapy is an effective treatment for schizophrenia? A cautious or cautionary tale? Behav Res Ther, 42(12), 1377–1401.
Tarrier, N., Kinney, C., McCarthy, E., & Wittkowski, A. (2001). Are some types of psychotic symptoms more responsive to cognitive behaviour therapy? Behavioural and Cognitive Psychotherapy, 29, 45–55.
Trower, P., Birchwood, M. J., Meaden, A., Byrne, S., Nelson, A., & Ross, K. (2004). Cognitive therapy for command hallucinations: Randomised controlled trial. British Journal of Psychiatry, 184, 312–320.
Turkington, D., Kingdon, D., & Turner, T. (2002). Effectiveness of a brief cognitive-behavioural therapy intervention in the treatment of schizophrenia. British Journal of Psychiatry, 180, 523–527.
Van der Gaag, M., Hageman, M. C., & Birchwood, M. (2003). Evidence for a cognitive model of auditory hallucinations. Journal of Nervous and Mental Disease, 191, 542–545.
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Birchwood, M., Trower, P. Cognitive Therapy for Command Hallucinations: Not a Quasi-Neuroleptic. J Contemp Psychother 36, 1–7 (2006). https://doi.org/10.1007/s10879-005-9000-y
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DOI: https://doi.org/10.1007/s10879-005-9000-y