Translating CBT for voices into a program for carers: a pilot study

Behav Cogn Psychother. 2012 Jan;40(1):117-23. doi: 10.1017/S1352465811000348. Epub 2011 Sep 9.


Background: The treatment of persisting psychotic symptoms with cognitive behavioural therapy (CBTp) is now established as an evidence-based treatment; however its availability remains limited. We piloted a novel CBTp skills-based group training program for carers. The aim was to reduce service users' auditory hallucinations severity through carers' use of basic CBTp methods in their regular interactions.

Method: Eight carer-service user dyads and one carer-carer-service user triad participated. Carers attended the 10-week (25-hour) program, and completed measures of subjective burden and expressed emotion (EE) over a 30-week period that included a baseline phase prior to the training and implementation phase. Service users completed weekly interviews assessing voice symptomatology. Analyses were conducted for each dyad using time-series methods.

Results: The training program was rated highly. Improvements in symptoms and carer burden ranged from none to clinically significant across different dyads. Carer implementation of strategies was related to reduced symptoms in one dyad; reductions in EE were related to symptom improvements in two dyads.

Conclusions: There may be benefits in training carers in behavioural and cognitive management of persisting hallucinations. Possible mechanisms for improvements in voice symptomatology include reduction in carers' EE, and carer implementation of strategies taught.

MeSH terms

  • Adaptation, Psychological
  • Adult
  • Aged
  • Caregivers / education
  • Caregivers / psychology*
  • Cognitive Behavioral Therapy / methods*
  • Cost of Illness
  • Expressed Emotion
  • Female
  • Hallucinations / psychology
  • Hallucinations / therapy*
  • Humans
  • Male
  • Middle Aged
  • Pilot Projects
  • Psychiatric Status Rating Scales
  • Psychotherapy, Group / education
  • Psychotherapy, Group / methods*
  • Psychotic Disorders / psychology
  • Psychotic Disorders / therapy*
  • Schizophrenia / therapy*
  • Schizophrenic Psychology*
  • Young Adult