Gurpreet Reen - Thesis submitted in partial fulfilment of the degree of Doctor of Clinical Psychology (DClinPsych)

Critical Review of the Literature
Negative voice content and distress in voice hearers is associated with ongoing negative health outcomes. Developmental trauma is common in people who hear voices. However, the role of early trauma on voice content and distress is unclear. The current review sought to determine the relationship between developmental trauma with voice content and distress in clinical and non-clinical voice hearers. A systematic search conducted in May 2023 using PsycINFO, CINAHL, PubMed, EMBASE and MEDLINE identified 15 studies. The majority of the studies were conducted with clinical voice hearers. Six studies assessed the relationship between developmental trauma and voice content in a voice hearing population and found that early trauma directly or indirectly influenced the content of voices. However, ten studies looking at the relationship between developmental trauma and subsequent distress reported mixed findings. Priorities for future research and clinical implications based on the findings from the present review are explored.
Service Improvement Project
Objectives: The aim of this service improvement project was to improve cultural competency of clinicians in an older adult psychological service. Cultural competency refers to promoting cultural awareness, humility, and sensitivity in the service, and developing clinician’s skills to integrate culture in assessment and therapy. Methods: Consultations with the service and racial and ethnic minoritised patients were conducted to inform the project. A mixed methods design was carried out with three phases: (i) an audit to review information from racial and ethnic minoritised patients accessing the service, (ii) focus groups with psychologists, and (iii) development of a guidance for clinicians and set of recommendations for the service, adapted with service feedback. Results: A total of 20 (10%) older adult patients accessing the service between 2018 to 2022 were from a racial and ethnic minoritised background. The findings of the project suggest that culture can impact presentation of mental health difficulties, beliefs and values about seeking help, and can also be a protective factor for patients. Conclusion: The current project helped draw out cultural factors that are important to address when working therapeutically with older racial and ethnic minoritised patients and culminated in guidelines and recommendations for the older adult psychological service.
Theory Driven Research Project
Young voice hearers who experience distress and persistent voices are vulnerable to negative health outcomes, especially if seeking help from mental health services. However, little is known about the voice hearing phenomenon in an adolescent help-seeking population without a diagnosis of a psychotic disorder. The current longitudinal study aimed to assess the relationship between negative voice content and distress, and identify potential predictors of voice persistence, in an adolescent help-seeking population. Thirty adolescents aged 13-18 years with various clinical presentations and no diagnosed psychotic disorder were recruited from two NHS sites. Baseline measures were conducted, and 16 adolescents were followed-up after three months. Young voice hearers mostly reported voices with a derogatory and threatening content, although also heard other voice content. Around 80% of young voice hearers heard persistent voices. Derogatory and threatening voice content, and reasons for listening to and believing this content, was significantly associated with distress. Derogatory and threatening voice content, reasons for listening to and believing this content, and social isolation showed small to medium effects on voice persistence. This study highlights the role of voice content as a predictor of distress, and potential factors that may drive voice persistence in younger people.

Advisor: Steel, C