[Pilot study of Experience Focused Counselling by nurses with people who hear voices: Evaluation of the implementation of the study protocol]. / Pilotstudie zu Erfahrungsfokussierter Beratung durch Pflegende bei Menschen, die Stimmen hören.

Pilot study of Experience Focused Counselling by nurses with people who hear voices: Evaluation of the implementation of the study protocol Abstract: Background: Hearing voices and the treatment and support of people who hear voices and are distressed by the experience are defined differently in psychiatry. In contrast to the medical approach to define and treat voices as symptoms of a disease, the EFC counselling approach developed with voice-hearers focuses on non-pathologizing acceptance and a constructive relationship to voices. Mental health nurses with their focus on everyday life are predestined for the dissemination and application of alternative therapeutic approaches in practice. Aim: The aim was to evaluate the study protocol as part of a pilot study regarding its suitability for a larger trial. Method: The multi centre pilot study had a single-blind randomised controlled design. The intervention consisted of EFC counselling by nurses with people who hear voices. The control group received Treatment As Usual (TAU). The suitability of the study design was evaluated in terms of recruitment, burden on study participants, suitability of assessment tools, the application of EFC counselling and the use of study nurses. Results: As planned 21 participants could be included in the study within fifteen months across the two study sites. Overall, the participants rated the study as not very burdensome and the intervention as helpful. The application of EFC by the nurses as well as the use of study nurses was assessed as good and suitable respectively. Discussion: The evaluation of the study protocol shows that with minor adjustments it is suitable for conducting a larger study.

Talk-based approaches to support people who are distressed by their experience of hearing voices: A scoping review.

Background: The positive effects of both antipsychotic medication and cognitive behavioral therapy in psychosis (CBTp) for people who are distressed by their experience of hearing voices remain limited. As a result, there has been a recent surge in talk-based individual approaches. Many of these continue not to be very well known nor implemented in practice. Some of the approaches may focus more on understanding and dealing constructively with voices, an element that has been identified as potentially helpful by voice hearers. Existing barriers to a wider implementation include both the widespread pathologization of hearing voices and a lack of mental health professionals who have been trained and trusted to carry out these new interventions. Methods: This scoping review aimed to identify and describe a current synthesis of talk-based individual approaches for people who hear voices, including studies independently of method of study or approach, diagnosis of voice hearers nor of the professional background of interventionists. Results: Nine different talk-based approaches were identified. These included: (1) Cognitive Behavioral Therapy for Psychosis (CBTp); (2) AVATAR therapy; (3) Making Sense of Voices (MsV) aka Experience Focused Counselling (EFC); (4) Relating Therapy; (5) Acceptance and Commitment Therapy; (6) Smartphone-based Coping-focused Intervention; (7) Prolonged and Virtual Reality Exposure Therapy; (8) Eye Movement Desensitization and Reprocessing, and (9) Individual Mindfulness-based Program for Voice Hearing. The different approaches differed greatly in relation to the number of sessions, length of time offered and the scientific evidence on efficacy. Psychologists represented the main professional group of interventionists. CBTp and the MsV/EFC approach also included health professionals, like nurses, as implementers. Most of the approaches showed positive outcomes in relation to voice related distress levels. None identified overall or voice specific deteriorations. Conclusion: There appears to be a strong case for the implementation of a broader heterogeneity of approaches in practice. This would also be in line with recommendations for recovery focused services and requirements of voice hearers. A greater emphasis on whole systems implementation and thus the involvement of frontline staff, like nurses, in the delivery of these approaches would likely reduce the research-practice implementation gap.

Experience Focussed Counselling with Voice Hearers: Towards a Trans-diagnostic Key to Understanding Past and Current Distress-A Thematic Enquiry.

As it is increasingly evident that distressing voices can be linked to traumatic events across diagnoses, there is a need for new transdiagnostic interventions for persons with voice hearing related distress. Twenty-five interviews with voice hearers and mental health professionals explored the trans-diagnostic suitability of Experience Focussed Counselling (EFC) compared to Treatment As Usual. An Applied Thematic Analysis was used. Themes identified were: intervention applicability; impact of regular treatment before study; impact of EFC process; process of working with voices; impact of regular treatment during study; views on treatment or approach. The EFC focus was considered helpful across diagnoses. The findings support EFC as a transdiagnostic intervention.