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    Trauma-focused imaginal exposure for auditory hallucinations: A case series

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    Author
    Brand, RM; Bendall, S; Hardy, A; Rossell, SL; Thomas, N
    Date
    2020-05-21
    Source Title
    Psychology and Psychotherapy: theory, research and practice
    Publisher
    WILEY
    University of Melbourne Author/s
    Bendall, Catherine; Rossell, Susan
    Affiliation
    Melbourne School of Psychological Sciences
    Centre for Youth Mental Health
    Metadata
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    Document Type
    Journal Article
    Citations
    Brand, R. M., Bendall, S., Hardy, A., Rossell, S. L. & Thomas, N. (2020). Trauma-focused imaginal exposure for auditory hallucinations: A case series. PSYCHOLOGY AND PSYCHOTHERAPY-THEORY RESEARCH AND PRACTICE, https://doi.org/10.1111/papt.12284.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/252416
    DOI
    10.1111/papt.12284
    Abstract
    OBJECTIVE: There is mounting evidence that traumatic life events play a role in auditory hallucinations (AH). Theory suggests that some AH are decontextualized trauma memory intrusions. Exposure-based trauma-focused therapies that target trauma memory intrusions may therefore be a promising new treatment. We aimed to assess the feasibility and acceptability of a standard protocol trauma-focused imaginal exposure intervention for trauma-related AH and to provide initial proof of concept regarding potential effects on AH. DESIGN: We conducted a single-arm case series of a six session (90 min per session) imaginal exposure intervention for trauma-related AH with assessments at baseline, post-therapy, and one-month follow-up. RESULTS: Fifteen people were recruited and eligible to start the intervention. Participants reported high levels of satisfaction; however, temporary distress and symptom exacerbation were common and contributed to discontinuation. There was a large reduction in AH severity at one-month follow-up (adjusted d = 0.99), but individual response was highly variable. There were also large reductions in post-traumatic stress disorder symptoms and the intrusiveness of the trauma memory. CONCLUSIONS: Imaginal exposure for trauma-related AH is generally acceptable and may have large effects on AH severity for some people. However, temporary distress and symptom exacerbation are common and can lead to discontinuation. Low referral rates and uptake also suggest feasibility issues for standalone imaginal exposure for AH. The intervention may be more feasible and acceptable in the context of a broader trauma-focused therapy. Well-powered trials are needed to determine efficacy and factors that impact on acceptability and therapy response. PRACTITIONER POINTS: Some AH can be understood as trauma memory intrusions that lack temporal and spatial contextualization and are therefore experienced without autonoetic awareness. Imaginal exposure to trauma memories associated with AH may be an effective intervention for some people. Temporary distress and symptom exacerbation may be common when using standard trauma-focused imaginal exposure for AH. This can impact on the acceptability of the therapy and should be considered in future development and delivery.

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