Imagery-focused cognitive behavioral therapy techniques for auditory verbal hallucinations in psychosis spectrum disorders: four experimental case series
Imagery-focused cognitive behavioral therapy techniques for auditory verbal hallucinations in psychosis spectrum disorders: four experimental case series
Background: in psychosis spectrum disorders, maladaptive mental imagery is associated with auditory verbal hallucinations (AVHs). This study evaluates the feasibility, acceptability, and effectiveness of the following 4 imagery techniques in targeting mental imagery and AVHs severity: Imagery Rescripting (ImRs), Promoting positive Imagery de novo (Pos-Im), Metacognitive Imagery techniques (Meta-Im), and playing Tetris.
Study design: four replicated single-case series experimental designs were used. Participants were randomized to 1 of the 4 treatment conditions. Primary, we measured the severity of mental imagery and AVHs thrice daily on an 11-point VAS scale during a 2-week baseline, throughout 3 weeks of therapy, and during a 2-week follow-up phase. Randomization tests were used to examine whether daily severity levels of momentary mental imagery and AVHs decreased post-therapy. Secondary, questionnaires assessing the severity of AVHs, mental imagery characteristics, and levels of mood, anxiety, and functioning were administered at baseline, before, and posttreatment.
Results: twenty-eight participants completed all treatment sessions. Mental imagery significantly decreased after ImRs (P < .001, d = 1.13) and Pos-Im (P = .039, d = 0.22), with no significant effects observed following Meta-Im or Tetris. AVHs significantly decreased with all treatment conditions, with largest effects for ImRs (P = .001, d = 1.39) and Pos-Im (P < .001, d = 1.99). Secondary results demonstrated reductions in the severity of AVHs, mood, anxiety, imagery frequency, and appraisals.
Conclusions: imagery techniques appear feasible and acceptable for addressing mental imagery and AVHs in the psychosis continuum and may be valuable additions to current treatment for AVHs.
Janssen, Hella
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van den Berg, Karin C.
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Keijsers, Ger P.J.
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Paulik, Georgie
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Newman-Taylor, Katherine
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Taylor, Christopher D.J.
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Steel, Craig
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Marcelis, Machteld C.
19a5f982-0660-423b-9465-51703ca933fc
10 April 2025
Janssen, Hella
6be40d58-7d98-412b-b8ed-7c2fe95a3b4c
van den Berg, Karin C.
17a54981-ae47-474f-b524-5ed94a0df71c
Keijsers, Ger P.J.
4deca356-c7e5-4c12-b603-7d365f6851c7
Paulik, Georgie
4a76d5da-31c8-456c-8885-7500f687a451
Newman-Taylor, Katherine
e090b9da-6ede-45d5-8a56-2e86c2dafef7
Taylor, Christopher D.J.
de5c7065-b194-41eb-bfa5-e6de32afc786
Steel, Craig
170e312a-f535-4a80-8b2c-6e0c62c9e912
Marcelis, Machteld C.
19a5f982-0660-423b-9465-51703ca933fc
Janssen, Hella, van den Berg, Karin C., Keijsers, Ger P.J., Paulik, Georgie, Newman-Taylor, Katherine, Taylor, Christopher D.J., Steel, Craig and Marcelis, Machteld C.
(2025)
Imagery-focused cognitive behavioral therapy techniques for auditory verbal hallucinations in psychosis spectrum disorders: four experimental case series.
Schizophrenia Bulletin, [sbaf033].
(doi:10.1093/schbul/sbaf033).
Abstract
Background: in psychosis spectrum disorders, maladaptive mental imagery is associated with auditory verbal hallucinations (AVHs). This study evaluates the feasibility, acceptability, and effectiveness of the following 4 imagery techniques in targeting mental imagery and AVHs severity: Imagery Rescripting (ImRs), Promoting positive Imagery de novo (Pos-Im), Metacognitive Imagery techniques (Meta-Im), and playing Tetris.
Study design: four replicated single-case series experimental designs were used. Participants were randomized to 1 of the 4 treatment conditions. Primary, we measured the severity of mental imagery and AVHs thrice daily on an 11-point VAS scale during a 2-week baseline, throughout 3 weeks of therapy, and during a 2-week follow-up phase. Randomization tests were used to examine whether daily severity levels of momentary mental imagery and AVHs decreased post-therapy. Secondary, questionnaires assessing the severity of AVHs, mental imagery characteristics, and levels of mood, anxiety, and functioning were administered at baseline, before, and posttreatment.
Results: twenty-eight participants completed all treatment sessions. Mental imagery significantly decreased after ImRs (P < .001, d = 1.13) and Pos-Im (P = .039, d = 0.22), with no significant effects observed following Meta-Im or Tetris. AVHs significantly decreased with all treatment conditions, with largest effects for ImRs (P = .001, d = 1.39) and Pos-Im (P < .001, d = 1.99). Secondary results demonstrated reductions in the severity of AVHs, mood, anxiety, imagery frequency, and appraisals.
Conclusions: imagery techniques appear feasible and acceptable for addressing mental imagery and AVHs in the psychosis continuum and may be valuable additions to current treatment for AVHs.
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Revised version_Imagery focused psychological intervention techniques in the treatment of auditory verbal hallucinations_main document_revised version_SB_27012025
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sbaf033
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e-pub ahead of print date: 10 April 2025
Published date: 10 April 2025
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Local EPrints ID: 501298
URI: http://eprints.soton.ac.uk/id/eprint/501298
ISSN: 0586-7614
PURE UUID: 716dd6af-88a1-43b1-9200-76008f68878a
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Date deposited: 28 May 2025 16:54
Last modified: 03 Sep 2025 02:00
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Contributors
Author:
Hella Janssen
Author:
Karin C. van den Berg
Author:
Ger P.J. Keijsers
Author:
Georgie Paulik
Author:
Christopher D.J. Taylor
Author:
Craig Steel
Author:
Machteld C. Marcelis
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