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Setting up, running and evaluating a CBT Hearing Voices Group

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 2 nd & 3 rd October 2012. Overview. Background Context

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Setting up, running and evaluating a CBT Hearing Voices Group

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  1. 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

  2. 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)

  3. Workshop Task • 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? Psychosis Clinical Academic Group (CAG)

  4. Background to HVGs • First groups via Hearing Voices Network, late 1980s • Network principles • Current Hearing Voices Network groups • NHS HVGs – increasing popularity • CBT groups Psychosis Clinical Academic Group (CAG)

  5. Benefits of CBT HVGs • 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 Psychosis Clinical Academic Group (CAG)

  6. The group • 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 Psychosis Clinical Academic Group (CAG)

  7. CBT HVG Manual • 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 Psychosis Clinical Academic Group (CAG)

  8. Service setting and client group • 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 Psychosis Clinical Academic Group (CAG)

  9. Setting up the group • Plan in advance • Practicalities – room; budget (refreshments, stationery, flipchart, name labels etc); DVD player; kettle, mugs etc • Time commitment Psychosis Clinical Academic Group (CAG)

  10. Recruitment Suggestions • Recruit from within your team • Rolling recruitment • Posters and leaflets • Encourage over-inclusiveness • Team meetings • Discuss each CC caseload • It can be very hard!! Psychosis Clinical Academic Group (CAG)

  11. Assessment Suggestions • 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 Psychosis Clinical Academic Group (CAG)

  12. 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)

  13. Obstacles? • What obstacles could people envisage arising in the setting up, running or evaluation of the group? Psychosis Clinical Academic Group (CAG)

  14. Roleplay an Obstacle Psychosis Clinical Academic Group (CAG)

  15. Questions? • If you decide to run the group in your local service, please do not hesitate to contact us with any queries.

  16. 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. Psychosis Clinical Academic Group (CAG)

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