Cognitive Therapy for Distressing Visual Hallucinations: A Pilot Study
Condition: Visual Hallucinations; Psychotic Disorders
MeSH terms: Hallucinations; Psychotic Disorders
Study type: Observational

Summary: 
      The study is a pilot study of Cognitive therapy for people with psychosis who have
      distressing visual hallucinations. The aim is to evaluate whether this is an acceptable,
      feasible and effective treatment. This is a pilot study and there is no randomisation to
      either CBT or treatment as usual (TAU). If a participant is allocated to the cognitive
      therapy plus TAU condition then the participant will meet with a therapist on initially a
      weekly basis and receive up to 8 sessions of CBT over a 2 month period. The participant will
      also have regular assessments conducted by a researcher who is independent to the treatment
      group. It is predicted that those people receiving CBT will improve on measures of symptoms,
      and particularly for measures of visual hallucinations.
    

Detailed description: 
      Cognitive behavioural therapy (CBT) has been proven to be effective in helping people with
      distressing psychotic symptoms such as auditory hallucinations or upsetting delusional
      beliefs. While the majority of hallucinations reported in psychotic disorders are auditory,
      visual hallucinations (VH) have been reported in 16%-72% of people with psychotic disorders
      like schizophrenia and schizoaffective disorder. VH appear to be associated with particularly
      high levels of distress, and impairment. The global severity of illness was significantly
      higher in people with schizophrenia and VH, as compared to those people without VH. Whilst
      antipsychotic medication is the first line of treatment for psychotic symptoms like VH, there
      is evidence that many service users choose to refuse or discontinue their pharmacological
      treatment. For example, the largest trial to compare atypical antipsychotics found that 74%
      of patients with a diagnosis of schizophrenia discontinued their medication over 18 months.
      Hence, there is a need to develop a range of effective treatments. Despite its value in
      treating auditory hallucinations, at present there is no specific CBT treatment for VH.

      We developed a cognitive behavioural model for visual hallucinations. This model has been
      tested in a recent study of 15 people with psychosis and distressing visual hallucinations
      which found that it was not the presence of the visual experience per se that led to the
      distress but the appraisal of it (as being a threat to psychological or physical wellbeing).
      Such appraisals are targeted in CBT for auditory hallucinations.

      The aim of this research is to assess the value of a manualised cognitive behavioural
      intervention for distressing visual hallucinations by establishing if it reduces distress and
      disability. The aim is to determine the acceptability of the treatment package, feasibility
      of recruitment, the ability to deliver the treatment manual as intended, retention in the
      treatment, a preliminary estimate of effect size and maintenance of any gains at a brief
      follow up.
    

Intervention name(s): CBT for Distressing visual hallucinations
Intervention type(s): Behavioral
Intervention description(s): Eight to ten sessions of manualised CBT for distressing visual hallucinations based on existing treatment manuals (ie. Kingdon & Turkington, 2004, Morrison et al., 2005), delivered over 8 to 12 weeks by CBT therapists.
Subjects will continue to receive treatment as usual throughout the therapy period and will receive appropriate prescription of medication if requested or clinically indicated.
Other intervention name(s): Cognitive Behavioural therapy for visual hallucinations
Observational model: Case-Only
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        People in Early Intervention in Psychosis services who are reporting distressing visual
        hallucinations in the past month.
      
Keywords: pilot study; CBT trial