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Trauma‐focused imaginal exposure for auditory hallucinations: A case series
Author(s) -
Brand Rachel M.,
Bendall Sarah,
Hardy Amy,
Rossell Susan L.,
Thomas Neil
Publication year - 2021
Publication title -
psychology and psychotherapy: theory, research and practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.102
H-Index - 62
eISSN - 2044-8341
pISSN - 1476-0835
DOI - 10.1111/papt.12284
Subject(s) - distress , context (archaeology) , discontinuation , exacerbation , psychology , exposure therapy , intervention (counseling) , randomized controlled trial , medicine , clinical psychology , psychiatry , anxiety , paleontology , biology
Objective There is mounting evidence that traumatic life events play a role in auditory hallucinations (AH). Theory suggests that some AH are decontextualized trauma memory intrusions. Exposure‐based trauma‐focused therapies that target trauma memory intrusions may therefore be a promising new treatment. We aimed to assess the feasibility and acceptability of a standard protocol trauma‐focused imaginal exposure intervention for trauma‐related AH and to provide initial proof of concept regarding potential effects on AH. Design We conducted a single‐arm case series of a six session (90 min per session) imaginal exposure intervention for trauma‐related AH with assessments at baseline, post‐therapy, and one‐month follow‐up. Results Fifteen people were recruited and eligible to start the intervention. Participants reported high levels of satisfaction; however, temporary distress and symptom exacerbation were common and contributed to discontinuation. There was a large reduction in AH severity at one‐month follow‐up (adjusted d = 0.99), but individual response was highly variable. There were also large reductions in post‐traumatic stress disorder symptoms and the intrusiveness of the trauma memory. Conclusions Imaginal exposure for trauma‐related AH is generally acceptable and may have large effects on AH severity for some people. However, temporary distress and symptom exacerbation are common and can lead to discontinuation. Low referral rates and uptake also suggest feasibility issues for standalone imaginal exposure for AH. The intervention may be more feasible and acceptable in the context of a broader trauma‐focused therapy. Well‐powered trials are needed to determine efficacy and factors that impact on acceptability and therapy response. Practitioner points Some AH can be understood as trauma memory intrusions that lack temporal and spatial contextualization and are therefore experienced without autonoetic awareness. Imaginal exposure to trauma memories associated with AH may be an effective intervention for some people. Temporary distress and symptom exacerbation may be common when using standard trauma‐focused imaginal exposure for AH. This can impact on the acceptability of the therapy and should be considered in future development and delivery.