Talking With Voices II

INTERVENTION: The study will employ the treatment manual devised and refined during the Talking With Voices feasibility and acceptability trial (https://www.isrctn.com/ISRCTN45308981), which utilises individualised formulations to identify key psychosocial conflicts associated with voice hearing and determine targeted treatment strategies and shared goals for relational change. An 8‐month treatment window permits =26 sessions, with an option for up to 4 booster sessions to consolidate therapeutic gains. A range of interventions with associated milestones is delivered within the treatment timeframe (e.g., psychosocial education, coping enhancement, psychological formulation, and dialogical engagement with voices). The manual adheres to general best‐practice principles for psychological therapy with psychosis patients, including building collaborative relationships, developing shared goals, using inclusive language, validating individual experiences, and providing hope that recovery is possible. In turn, these principles underpin many of the specific values of Talking With Voices, which can be summarized as the following: 1. A normalising approach: voice‐hearing is recognized as a common human experience that may cause distress but from which many people recover. Consistent with the ethos of the user‐led Hearing Voices Movement, the concept of recovery is not solely defined by the cessation of clinical symptoms as opposed to reducing distress and promoting positive goals, with full recognition that individuals can live fulfilling lives as voice‐hearers. 2. A user‐led intervention: clients have a central role in determining the pace and goals of therapy and identifying the most useful strategies to cope with their experi CONDITION: Psychosis ‐ hallucinations ; Mental and Behavioural Disorders PRIMARY OUTCOME: Personal mental health recovery measured using the Questionnaire About the Process of Recovery (QPR) at 8 months (post‐treatment). QPR data will also be collected at baseline, 8 months, and 14 months. INCLUSION CRITERIA: The study population are adult users of mental health services with severe mental health problems (SMHP) who hear persistent, distressing voices. 1. Aged > = 16 years 2. Heard voices for at least a year 3. Scoring > = 1 on item 8 of the Psychotic Symptom Rating Scales–Auditory Hallucinations Subscale (PSYRATS‐AH) 4. Able to provide written informed consent 5. Actively help‐seeking in relation to distressing voices 6. In contact with mental health services for > = 6 months 7. Willing and able to communicate with their voices and relay what the voices say to a therapist 8. Hear voices that are sufficiently personified to engage in dialogical work SECONDARY OUTCOME: ; Secondary outcome measures are assessed at baseline, 8 months, and 14 months unless otherwise stated:; 1. Voice hearing phenomenology and impact measured using the Psychotic Symptoms Rating Scale – Auditory Hallucinations Subscale; 2. Attitudes and actions in relation to voices measured using the Voices Acceptance and Action Scale; 3. The presence and impact of non‐auditory hallucinations measured using the Psychotic Symptoms Rating Scale: Multimodal Hallucinations; 4. Trauma‐related symptoms measured using the PTSD Checklist for DSM‐5; 5. Connections between adverse life events and voices measured using the Trauma Voice Associations Questionnaire; ; Mechanistic outcome measures assessed at baseline, 8 months, and 14 months:; 1. Negative self‐beliefs measured using the Brief Core Schema Scale; 2. Dissociative symptoms measured using the depersonalisation/derealisation subscale of the Revised Dissociative Experiences Scale; 3. Beliefs and emotional and behavioural reactions to voices measured using the Revised Beliefs About Voices Questionnaire; 4. Assertiveness in response to voices measured using the Approve–Voices Questionnaire; ; Assessment of baseline characteristics:; The incidence of clinically significant traumas measured using the Trauma and Life Events Checklist at baseline;