Antipsychotic medications do not always banish auditory hallucinations from
the lives of schizophrenia patients. And when that is the case, how can
patients cope with the voices that plague them?
Perhaps by participating in an eclectic therapy being explored by Dutch
psychiatrist Durk Wiersma, M.D., a professor of clinical epidemiology in
psychiatric disorders at the University of Groningen, and colleagues in the
The therapy, called Hallucination-Focused Integrative Treatment (HIT),
appears to improve the quality of life and social functioning of patients who
have suffered from auditory hallucinations for a long time, a study conducted
by Wiersma and his team suggests.
The HIT therapy offers schizophrenia patients whose auditory hallucinations
are not being eliminated by antipsychotic medications some
cognitive-behavioral therapy (CBT) techniques for dealing with those
hallucinations. The program is directed to the families of schizophrenia
patients as well as to the patients themselves; in this way it differs from
most CBT interventions.
For instance, in HIT therapy, hallucinations are viewed as a reality for
which the patients themselves are held responsible. Patients are asked to
monitor the characteristics of their "voices" on a daily basis and
to note triggering events. Ideas about "voices" are shared and
challenged in therapy. Both patients and their relatives are encouraged to
come up with new ideas about and solutions to deal with patients'"
HIT therapy is usually offered to patients and their families in 20
one-hour sessions over nine months.
Although Wiersma and his colleagues, as well as other clinicians, have been
using HIT to help schizophrenia patients deal with their hallucinations, no
study has been conducted to test the therapy's effectiveness.
Thus, the researchers conducted a trial with 63 schizophrenia patients who
were similar on sociodemographic, diagnostic, medication, and medical history
variables and who had been suffering from auditory hallucinations for an
average of 11 years in spite of antipsychotic medications.
Thirty-two of the patients were randomly allocated to receive care as
usual— that is, regular medical contacts, home visits, day-care
activities, psychosocial education for patients and families, and supportive
counseling. The remaining 31 patients received HIT plus routine care. All of
the subjects continued to receive antipsychotic medications during the study,
and the kind and amount that each subject received during the study were
The researchers used a 26-item self-report questionnaire, the World Health
Organization Quality of Life Schedule, and a semistructured interview, the
Groningen Social Disabilities Schedule, to assess quality of life and social
functioning of the subjects at the start of the study; at nine months into the
study, that is, after HIT therapy had ended; and 18 months after the study
began. The World Health Organization Quality of Life Schedule measured factors
such as sleep, safety, enjoyment of life, and satisfaction with life; the
Groningen Social Disabilities Schedule measured factors such as the quality of
relationships with family, partners, or friends and ability to carry out
household or work activities.
The investigators then compared the quality of life and social functioning
of the HIT subjects with those of the control subjects.
With regard to quality of life, HIT subjects improved steadily in almost
every domain throughout the study and significantly so by the 18-month
follow-up. The controls, in contrast, did not show such improvement.
On social-functioning measures, HIT subjects improved significantly in five
of the eight assessed domains by nine months into the study. In contrast,
controls hardly improved at all. What's more, the HIT group maintained their
improvements at nine months and at the 18-month assessment.
Finally, the researchers looked to see whether their results might have
been distorted by the kinds and amounts of antipsychotic medications subjects
had taken during the study or by other variables, but found no such
These data "suggest a significant improvement of quality of life and
in particular in social-role functioning" for HIT subjects, Wiersma and
his team concluded in their report, which was published in the March Acta
True, Wiersma told Psychiatric News, HIT therapy may not banish
auditory hallucinations, but the burden of such hallucinations can be relieved
by HIT therapy "better than was initially expected."
Peter Weiden, M.D., a professor of psychiatry at the State University of
New York Downstate Medical Center and a specialist in the use of CBT for
schizophrenia, told Psychiatirc News, "This is the kind of
rigorous, randomized, controlled clinical trial that is being done in other
countries and that looks at the impact of CBT and related psychosocial
treatments on active symptoms of schizophrenia. The U.S. is way behind in
The study was financed by the Ziekenfondsraad, a health care advisory body
of the Dutch government.
An abstract of the study, "Hallucination-Focused Integrative
Treatment Improves Quality of Life in Schizophrenia Patients," is posted