Cognitive therapy for command hallucinations: randomised controlled trial
Open accessAbstract
Background: Command hallucinations are a distressing and high-risk group of symptoms that have long been recognised but little understood, with few effective treatments. In line with our recent research, we propose that the development of an effective cognitive therapy for command hallucinations (CTCH) would be enhanced by applying insights from social rank theory. Aims: We tested the efficacy of CTCH in reducing beliefs about the power of voices and thereby compliance, in a single-blind, randomised controlled trial. Method: A total of 38 patients with command hallucinations, with which they had recently complied with serious consequences, were allocated randomly to CTCH or treatment as usual and followed up at 6 months and 12 months. Results: Large and significant reductions in compliance behaviour were obtained favouring the cognitive therapy group (effect size=1.1). Improvements were also observed in the CTCH but not the control group in degree of conviction in the power and superiority of the voices and the need to comply, and in levels of distress and depression. No change in voice topography (frequency, loudness, content) was observed. The differences were maintained at 12 months' follow-up. Conclusions: The results support the efficacy of cognitive therapy for CTCH.
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Use of good emotion regulation strategies leads to a reduction in the intensity and distress associated with auditory hallucinations.
“Studies have shown that the use of good emotion regulation strategies leads to a reduction in the intensity and distress associated with auditory hallucinations (32, 33).”
From Mobile intervention for individuals with psychosis, dual disorders, and their common comorbidities: A literature review (2019) · cites this paper as [33]
The “Distress and depression” section reports that the intensity of distress fell significantly in the cognitive-therapy group at six months, but the groups no longer differed at 12 months. The “Psychotic symptoms” and “Change in beliefs” sections report no sustained reduction in hallucinations themselves. The intervention targeted beliefs about the power of command voices, not emotion-regulation strategies as such. Page numbers are unavailable in our copy. (LLM, conf=0.87)
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- Authors
- Trower, P., Birchwood, M., Meaden, A., Byrne, S., Nelson, A., & Ross, K.
- Affiliations
- University of Birmingham (GB)
- Corresponding author
- Birchwood, Max
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2004-04
- Volume
- 184
- Issue
- 4
- Pages
- 312-320
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2075213101
- Cited by
- 268
- References
- 22
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 2 · 2023: 1 · 2022: 5 · 2021: 9 · 2020: 10 · 2019: 14 · 2018: 8 · 2017: 11 · 2016: 13 · 2015: 12 · 2014: 24 · 2013: 16 · 2012: 23
- FWCI
- 7.93
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Life Sciences › Neuroscience › Cognitive Neuroscience › Hallucinations in medical conditions
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- command hallucinations, cognitive therapy, compliance behavior, psychosis, depression, treatment efficacy
- MeSH terms
- Adult, Auditory Perception, Female, Hallucinations, Humans, Internal-External Control, Male, Middle Aged, Psychiatric Status Rating Scales, Schizophrenia, Schizophrenic Psychology, Cognitive Behavioral Therapy, Single-Blind Method, Treatment Outcome
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