Treatment of Resistant Command Hallucinations

INTERVENTION: Auditory hallucinations (AHs), often described as voices, are a common symptom of schizophrenia and related psychoses. Command hallucinations (CHs) are a type of auditory hallucinations in which the voice heard by the patient commands him or her to perform a particular action. When heard, such commands often impose great pressure for obedience. CHs frequently urge dangerous acts and are associated with greater levels of disability and distress compared to patients with non‐command AHs. Although anti‐psychotic medication is helpful in preventing compliance, it is not fully effective. We are conducting a randomised controlled trial evaluating the efficacy of a mindfulness‐based cognitive behavioural treatment for CHs (TORCH: Treatment of Resistant Command Hallucinations). The aim of TORCH is to reduce the distress, worry and harmful or self‐defeating behaviour associated with CHs. Treatment comprises 15 sessions with a psychologist, normally conducted at weekly intervals. CONDITION: Command hallucinations in psychotic disorders PRIMARY OUTCOME: Compliace with distress Compliance with CHs SECONDARY OUTCOME: Beliefs about voices, general psychopathology (illness severity), depression, psychological adaptation to psychosis, insight, quality of life. INCLUSION CRITERIA: Current diagnosis of schizophrenia, schizoaffective disorder, psychosis not otherwise specified or mood disorder with psychotic features; have experienced command hallucinations over previous 6 months that have cause distress or dysfuntion despite receiving treatment with anti‐psychotic medication at doses in therapeutic range.