Cognitive Treatments of Hallucinations in Schizophrenia

University Of Illinois At Chicago, Chicago IL

Investigators

Abstract

DESCRIPTION (provided by applicant): An estimated 30% of individuals with schizophrenia are not responsive to antipsychotic medication and continue to suffer from distressing positive symptoms such as delusions and hallucinations. Hallucinatory experiences in this population negatively impact quality of life and daily functioning in a variety of ways including reduced ability to maintain attention and focus due to distraction by auditory hallucinations (AH), chronically increased distress due to the often abusive nature of AH, and in some cases, serious suicide attempts in direct response to AH. Recent reviews of studies of cognitive treatments for persistent, unremitting AH indicate that these treatments effect significant clinical improvement in 25% - 50% of chronic schizophrenia patients whose AH were previously considered untreatable. Specifically, cognitive behavioral treatments adapted from those used to successfully treat mood disorder patients, have been shown to be effective in treatment of AH. To date, it is unclear which components of cognitive treatment are most useful in effecting a change in AH. The core elements of these interventions all involve some aspect of controlling attention either toward (focusing) or away from (distracting) the AH. Such strategies may have limited longterm effectiveness in that they rely heavily on selective attention mechanisms which are well-documented to be impaired in individuals with schizophrenia. However, targeted rehabilitation of selective attention impairment has been demonstrated in several case examples to improve functioning and quality of life in schizophrenia patients with unremitting AH. Therefore, one goal of the proposed work is to conduct the first treatment outcome study of selective attention training for auditory hallucinations in schizophrenia. In response to recent review of research on psychological treatments for AH and their methodological shortcomings, the proposed study also examines the effects of these treatments on psychosocial functioning, AH symptomatology, general psychopathology, and quality of life. Additionally, a novel aspect of the present study is the inclusion of measures of daily rest-activity cycles (using actigraphy) and AH dimensions to observe pre-, mid- and post-intervention relationship between AH and circadian rhythm. The findings of the proposed study will determine parameters (e.g., effect size, power) for a larger study examining the components of cognitive and cognitive behavioral interventions that are critical to symptom amelioration and improved functioning in individuals with schizophrenia.