Hearing Voices Group. Introduction. And. Background information. David DddddFreemanvvvvvvvvv

Transcription

1 Hearing Voices Group Introduction And Background information David DddddFreemanvvvvvvvvv

2 Contents Hearing Voices Group Rationale Inclusion criteria for hearing voices group Structure of Group Process The Assessment Process The Referral Process Contact point Appendix A Appendix B Appendix C page3 page5 page7 page9 page10 page11 page12 page26 page29 2

3 Hearing Voices Group Rationale The National Service Framework Modern Standards and Service Models standards 4and 5 (Doh, 1999) reviewed the evidence in favour of cognitive interventions for clients with psychosis, and concluded that cognitive approaches are of benefit for this client group. Cognitive behavioural Therapy has been shown to reduce both the frequency of voices and the distress caused by them in a small trial carried out by McLeod, T., Morris, M., Birchwood, M. and Dovey, A. (2007). The control that hallucinatory voices exert over clients behavior has been shown to be significantly reduced by cognitive behaviour therapy delivered in a group setting by Chadwick, P., Sambrooke, S., Rasch, S. and Davies, E. (2000). Who also demonstrate that this was principally achieved by modifying clients beliefs about the identity, intent and power of the voices. It has been shown by Wykes, T., Hayward, P., Thomas, N., Green, N., Surguladze, S., Fannon, D. and Landau, S. (2005).that the distress caused by hallucinatory voices can be reduced much more easily than the actual presence of voices and according to Wykes, T. (2004), given the large number of clients whose voices are resistant to medication either partially or totally there is a strong need for a hearing voices group. 3

4 Inclusion criteria for hearing voices group The client is appropriate for the hearing voices group if the client; Has a named Secondary level Care coordinator and a Community Psychiatric Nurse or Social Worker or other professional who may offer the client ongoing support. Has experienced distress due to hearing voices, at least once in the last month. Has a medical diagnosis of a psychotic illness made by a consultant psychiatrist Is happy to attend the hearing voices group.. Has good insight into their condition. Clients are not appropriate for the hearing voices group if they; Have ever been physically violent to another person. Have attempted suicide or self harm with in the last 6months, or who have had persistent suicidal ideation involving a desire to harm or kill themselves in that time. Have been verbally aggressive to another person within the last 6months 4

5 Are not receiving secondary level care coordination and have no community support from mental health professionals i.e. no CPN or social worker involved in their care on an ongoing basis. Are not able to abstain from drugs or alcohol whilst attending the hearing voices group. Are attending the hearing voices group under duress Has poor insight into their condition..has not experienced distress due to hearing voices within the last month. 5

6 Structure of Group Process The hearing voices group will consist of 15 weekly sessions each of 2 hours duration s and will be facilitated by two qualified mental heath professionals one of whom will be a mental heath nurse. The group will run with a maximum of 8 clients and a minimum of 4 clients, and will be a closed group; the facilitators reserve the right to discontinue the group if the number of clients attending falls below 4. Clients should attend for all sessions and if a client misses more than 2 sessions the facilitators reserve the right to ask the client to leave the current group and instead transfer to the next group. The group will utilize cognitive behavioral therapy for hearing voices and its content has been validated by Mr. Gerald Weldon Lead Cognitive Behavioral Psychotherapist. Each Session will consist of an initial welcome to the group and a discussion of how each client s week has been integrated with the experiences that the client has had with the weekly home work tasks and any resulting learning experiences. The group material for each session will be covered and a break for tea will take place in the middle of the session. At the end of each session homework tasks will be given and there will be an opportunity for clients to speak with the facilitators regarding any issue that they do not want to discuss in the group. The initial sessions of the group will be low key and devoted to building rapport and group cohesion, clients will be given the opportunity to discuss their experiences of illness and healthcare and to vent any thoughts and feelings that they may have. 6

7 The ethos of the hearing voices group is collaborative working and clients will be offered different explanations for voice hearing and will be offered various tools that have an evidence base indicating that they are likely to reduce the distress that voice hearers may experience. However clients will not be put under any pressure to accept or to use any particular concept or technique. The group will follow a program of psycho education about hearing voices which will be followed by strategies to reduce the emotional arousal associated with voice hearing. The cognitive therapy module will be introduced by applying the standard cognitive therapy techniques of thought diaries, the challenging of unhelpful negative automatic thoughts and behavioral testing to the beliefs about voices. to the anxiety and low mood that may be associated with voice hearing and will then be applied to client s beliefs about the voices identity, intention towards the client and to the voices power over the client. Next behavioral therapy techniques of relaxation, problem solving, exposure therapy for anxiety and behavioral activation for low mood and low motivation will be introduced. Finally clients will be assisted to create a relapse prevention plan and a follow up group session to monitor how clients has progressed at which their current BAVQ-R score will be measured, will be arranged for a month later. The session outlines are available for all 15 sessions of the hearing voices group in appendix A 7

8 The Assessment Process The Assessment will consist of 3 separate sessions per client of one hour each; this is best practice for CBT based hearing voices groups and is necessary to - screen for suitability/severity - ascertain full detailed history of voice hearing - ascertain current coping strategies - Carry out motivational Interviewing/educate about the group. These assessments will be carried out at the Poplars Brierley Hill CMHT, and will be conducted by two qualified mental heath professionals one of whom will be a mental heath nurse. The Assessment Process will be based on an abridged version of the Maastricht Assessment by Romme and Escher and will include clients taking away the Revised Beliefs about Voices Questionnaire to complete at Home. After the assessment process is complete clients will be posted a copy of the assessment and the result. 8

9 The Referral Process Clients may self refer by completing a self referral to the Hearing Voices Group Form and returning the completed form to the reception of the relevant CMHT or outpatients for posting to myself at the Therapeutic Recovery Service. Flyers, Pre addressed envelopes, information leaflets and Self referral to the Hearing Voices Group forms will shortly be ed to the CMHTs and to The Henry Lauch Centre. A self referral Form is included in Appendix B Care Coordinators may refer clients who appear to meet the attached criteria by means of a referral letter briefly describing the client s mental health problems and background information; provided that the clients full details are on SEPIA. 9

10 Contact Point Completed Referral forms should be returned to: David Freeman Hearing Voices Group Co Facilitator The Therapeutic Recovery Service The Poplars CMHT Little Cottage Street Brierley Hill DUDLEY West Midlands DY5 1RG If you need further hearing voices group flyers leaflets or envelopes or if you require any further information about the Hearing Voices Group please do not hesitate to contact myself on

11 Appendix A Session one Outline Welcome to hearing voices group 1. Therapists introduce themselves 2. Housekeeping 3. Ground rules for the Group 4. Getting the best from the group 5. Icebreaker including feedback from exercise. Break 6. Facilitate discussion/ thought shower about voices hearers experiences including stigma, professionals attitudes clients experience of voices and their impact, identity intent, power and 7. Outside tasks: BAVQ 11

12 Session 2 Outline 1. Review the previous week 2. Facilitate discussion on group members different problems that the voices cause in life 3. Give out Problems handout and get group members to generate some problems. 12

13 Session 3 Outline Facilitate discussion on people s problems and targets and hopes and fears about change. 1. Review homework 2. The Change Process Example Text 3. The Change Process Balance Sheet example 4. The Change Process Balance Sheet 5. Break 6 Targets 7. Outside practice: Change Process Balance Sheet, Problems and Targets. 13

14 Session 4 Outline 4. Review Homework 5. Facilitate discussion on group members different explanations for voices encourage non judgemental attitude about the truth of different explanations but gently explore how much power the different explanations give the user over the voices. 6. Break 7. Discuss what Brain scans may tell us about voice hearing 8. Give out handout: Are all explanations equally useful? Outside Tasks: Read Handout. 14

15 Session 5 Outline 9. Review Homework 10. Stress and vulnerability model Break 11. The 5 systems model Outside Tasks: Read Handouts on the stress and vulnerability model and on the 5 systems model. 15

16 Session 6 Outline 1. Review homework 2. Distress Tolerance Skills 3. Break 4. Relaxation through letting go 5. Outside Tasks: Practise Relaxation every day. i. Try one new coping skill from the distress tolerance skills list skills list each day and complete coping diary. 16

17 Session7 Outline 6. Review homework 7. Distress Tolerance Skills what worked 8. Break 9. Mindfulness meditation -Mindfulness meditation and mindfulness instruction handouts 10. Practice- facilitators join in, and guide. 11. Feedback debrief. 12. Outside Tasks: Practise Relaxation every day. i. Try one new coping skill from the distress tolerance skills list skills list each day and complete coping diary. ii. Practice mindfulness meditation each day. 17

18 Session 8 Outline 1. Review homework 2. Mindfulness meditation 3. Break 4. Thought and Emotion 5. Group exercise thoughts facilitate discussion on first thoughts vs hot thoughts 6. 5 systems monitoring 7. Outside Tasks: Practise Relaxation every day. i. Client to try a coping skill from the distress tolerance skills list that works for the client and to complete coping diary. ii. Practice mindfulness meditation daily iii. Complete 5 systems monitoring form 18

19 Session 9 Outline 8. Review homework 9. Mindfulness meditation systems monitoring example 11. Break 12. Detective work 13. Thought diary example 14. Introduce concept of experimental testing of thoughts 15. Outside Tasks: Practise Relaxation every day. i. Client to try a coping skill from the distress tolerance skills list that works for the client and to complete coping diary. ii. Practice mindfulness meditation daily iii. Complete 5 systems monitoring form iv. Complete Thought diary. 19

20 Session 10 Outline 16. Review homework 17. Detective work 18. Voices as Triggers 19. Break 20. Thought Diary 21. Experiments to test thoughts example 22. Outside Tasks: Practise Relaxation every day. i. Client to try a coping skill from the distress tolerance skills list that works for the client and to complete coping diary. ii. Practice mindfulness meditation daily iii. Complete 5 systems monitoring form and a thought challenging diary. iv. Complete Experimental record 20

21 Session 11 Outline Review homework 23. Problem solving 24. Break 25. Problem solving example Outside Tasks: Practise Relaxation every day. i. Client to try a coping skill from the distress tolerance skills list that works for the client and to complete coping diary. ii. Practice mindfulness meditation daily iii. Complete 5 systems monitoring form and a thought challenging diary. iv. Problem solving 21

22 Session 12 Outline Review homework 26. Break 27. Activity handout Outside Tasks: Practise Relaxation every day. i. Client to try a coping skill from the distress tolerance skills list that works for the client and to complete coping diary. ii. Practice mindfulness meditation daily iii. Complete 5 systems monitoring form and a thought challenging diary. iv. Activity Scheduling 22

23 Session 13 Outline Review homework Break 1. Adding in a new activity 2. Activity Schedule Outside Tasks: Practise Relaxation every day. v. Client to try a coping skill from the distress tolerance skills list that works for the client and to complete coping diary. vi. Practice mindfulness meditation daily vii. Complete 5 systems monitoring form and a thought challenging diary. viii. Problem solving ix. Schedule in new activities 23

24 Session 14 Outline Review homework 28. How to Become more active 29. Changing activity 30. Pessimistic thoughts 31. Break 4. Worry Fear and anxiety handouts Carrying out exposure based work 6. Exposure example Outside Tasks: Practise Relaxation every day. i. Client to try a coping skill from the distress tolerance skills list that works for the client and to complete coping diary. ii. Practice mindfulness meditation daily iii. Complete 5 systems monitoring form and a thought challenging diary. iv. Activity Scheduling (new activity) v. Step ladder exercise 24

25 Session 15 Outline Review homework Self- management plan.- facilitate client example Break Course feedback Outside Tasks: Complete Self management plan BAVQ Client to finish Self management plan. Farewell social tea and cakes etc clients and staff to bring. 25

26 Appendix B SELF REFERRAL FORM TO THE HEARING VOICES GROUP Name:. Address:... Date of Birth: Home Telephone Number:... Mobile Number:... Name of Consultant:.. Name of Care Co-ordinator:... Have you been distressed by Hearing Voices in the last month? * Please tick one box YES NO 26

27 Can you tell us about your problems (describe your voices, or tell us anything that you think might help us to decide how we may help you). (Continue on the back of form if you need more space) *When you have completed the form, you can either hand it back to reception or send by post to: David Freeman, Mental Health Nurse, Therapeutic Recovery Service, Poplars, Little Cottage Street, Brierley Hill, DY5 1RG. If you would like any further information, please call David Freeman on Can you tell us about your problems (describe your voices, or tell us anything that you think might help us to decide how we may help you). 27

28 Client Signature: Date:.. 28

29 Appendix C References Chadwick, P., Sambrooke, S., Rasch, S. and Davies, E. (2000), Challenging the omnipotence of voices: group cognitive behaviour therapy for voices, Behaviour Research Therapy, Vol.38, No.10, pp McLeod, T., Morris, M., Birchwood, M. and Dovey, A. (2007), Cognitive behavioural therapy group work with voice hearers. Part 1, British Journal of Nursing, Vol.16, No. 4, pp ] Wykes, T., Hayward, P., Thomas, N., Green, N., Surguladze, S., Fannon, D. and Landau, S. (2005), What are the effects of group cognitive behaviour therapy for voices? A randomised control trial, Schizophrenia Research, Vol.77, No. 2-3, pp Wykes, T. (2004), Psychological treatment for voices in psychosis, Cognitive Neuropsychiatry. Vol. 9, No 1-2, pp Department of Health (DoH) (1999), National Service Frameworks for Mental Health; Standards and Service Models, DoH, London. pp