| Learning Objective #1: Analyze the quality of life of individuals who experience distressing, neuroleptic-resistant auditory hallucinations | |||
| Learning Objective #2: Evaluate the efficacy of two interventions that target the auditory hallucinations of persons assigned a DSM-IV diagnosis of schizophrenia |
Recent clinical trials indicate potential benefits of cognitive therapy for the self-management of intrusive, malevolent, hard-to-avoid auditory hallucinations. The purpose of this repeated measures, quasi-experimental comparison study was to determine the efficacy of a cognitive nursing intervention (CNI) for improving health-related quality of life of 32 mostly white, community-dwelling voice hearers assigned a DSM-IV diagnosis of schizophrenia. The research was grounded in the perspective that voice hearers can enhance their ability to relate in a meaningful way with both themselves and their "voices" by considering the holistic nature and worthiness of particular voice events. Subjects were randomly assigned to receive CNI plus standard care (CNI+ST) (n=17) or standard care (ST) (n=15). Participants in the CNI+ST condition received 90-minute sessions of CNI each week over a period of 12 weeks. Subjects completed an inventory of their voice experiences at the beginning of the sessions; and developed cue cards as prompts for coping in the later half of the sessions. Data on outcome variables were obtained at baseline, 3 months, and 15 months after initiation of treatment. According to the research, subjects in the CNI+ST condition relative to the ST condition, reported significantly more improvement in depression and other psychiatric symptoms, self-esteem, and health-related quality of life; and limited improvement in subjective deficit symptoms. Although subjects in both conditions reported significant improvement in distressing auditory hallucinations, only the subjects in the CNI+ST condition sustained the improvement over time. At a 3 month follow-up evaluation, 12 (70.1%) CNI+ST subjects and no ST subjects showed a 50% or greater improvement in psychiatric symptoms, self-esteem, and health-related quality of life. One year later, 11 of the 12 (91.7%) CNI+ST subjects had sustained their gains. These findings provide encouragement for researchers to continue with development of cognitive nursing interventions for the self-management of distressing auditory hallucinations.
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