Setting up, running and evaluating a CBT Hearing Voices Group Dr Anna Ruddle & Dr Steven Livingstone...
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Transcript of Setting up, running and evaluating a CBT Hearing Voices Group Dr Anna Ruddle & Dr Steven Livingstone...
Setting up, running and evaluating a
CBT Hearing Voices Group
Dr Anna Ruddle & Dr Steven Livingstone (Clinical Psychologists)Psychosis Clinical Academic Group (CAG)
South London and Maudsley NHS Trust
ISPS UK Conference 2nd & 3rd October 2012
Psychosis Clinical Academic Group (CAG)
Overview
• Background Context
• Benefits of CBT Hearing Voices Groups
• Group Description and Roleplay
• Setting up the Group
• Recruitment and Assessment
• Evaluating the Group
• Overcoming Obstacles and Roleplay
Psychosis Clinical Academic Group (CAG)
• What experience do you have of working with people who hear voices?
• What experience do you have of running groups?
• What made you choose this workshop?
Workshop Task
Psychosis Clinical Academic Group (CAG)
• First groups via Hearing Voices Network, late 1980s
• Network principles
• Current Hearing Voices Network groups
• NHS HVGs – increasing popularity
• CBT groups
Background to HVGs
Psychosis Clinical Academic Group (CAG)
• Evidence base – Ruddle et al., 2011
• Increasing access to CBT (NICE recommended)
• Normalising a stigmatised experience
• Safe space to try new beliefs and behaviours
• Decreasing social isolation
Benefits of CBT HVGs
Psychosis Clinical Academic Group (CAG)
• 7-sessions, weekly, 1hr-1hr15mins• Closed group• 6-8 ideal; bear in mind drop-out• Facilitators x2; past experience• Manualised; balance of structure/open
discussion• Group aims – reduce distress, possibly by
enhancing coping and challenging negative beliefs about voices
The group
Psychosis Clinical Academic Group (CAG)
Adapted from Wykes et al.’s (1999) manual:• Session 1 – Sharing information about voices• Session 2 – Explanations of voices• Session 3 – Coping strategies• Session 4 – Beliefs about voices• Session 5 – Stigma and discrimination• Session 6 – Self-esteem• Session 7 – Overall model of voices
CBT HVG Manual
Psychosis Clinical Academic Group (CAG)
• Usually community-based teams
• Other settings/client-groups possible
• Evidence based on clients with a schizophrenia-spectrum diagnosis
• Clients who currently report hearing voices that cause distress and/or limit their functioning
Service setting and client group
Psychosis Clinical Academic Group (CAG)
• Plan in advance
• Practicalities – room; budget (refreshments, stationery, flipchart, name labels etc); DVD player; kettle, mugs etc
• Time commitment
Setting up the group
Psychosis Clinical Academic Group (CAG)
• Recruit from within your team
• Rolling recruitment
• Posters and leaflets
• Encourage over-inclusiveness
• Team meetings
• Discuss each CC caseload
• It can be very hard!!
Recruitment Suggestions
Psychosis Clinical Academic Group (CAG)
• Recommend individual assessments
• Facilitator/s to conduct
• Service user co-conduct
• Aims: engage; normalise; offer information; reassurance; assist informed decision; check suitability; do outcomes
• 30 mins approx
• Incorporate into asst for 1:1 therapy
Assessment Suggestions
Psychosis Clinical Academic Group (CAG)
Evaluation
Based on our experience:
• CORE-OM (self-report questionnaire)
• PSYRATS (semi-structured interview)
• 2 self-identified goals for the group (VAS scale 0-10) – see CHOICE
• Qualitative feedback (semi-structured interview)
Psychosis Clinical Academic Group (CAG)
• What obstacles could people envisage arising in the setting up, running or evaluation of the group?
Obstacles?
Questions?
• If you decide to run the group in your local service, please do not hesitate to contact us with any queries.
Psychosis Clinical Academic Group (CAG)
Key References• Romme, M. & Escher, S. (1993). Accepting voices. Dorset, UK:
Blackmore Press - Sets out the normalising approach used by the Hearing Voices Network, alternative ways of understanding voices, and interesting first hand accounts from voice-hearers.
• Ruddle, A., Mason, O., & Wykes, T. (2011). A Review of Hearing Voices Groups: Evidence and Mechanisms of Change. Clinical Psychology Review, 31, 757-766. – Overview of different HVG approaches and their evidence-base.
• Wykes, T., Parr, A., & Landau, S. (1999). Group treatment of auditory hallucinations: Exploratory study of effectiveness. British Journal of Psychiatry, 175, 180-85. – Developed the original CBT manual we have now adapted.