Imagery-Focused Cognitive Behavioral Therapy Techniques for Auditory Verbal Hallucinations in Psychosis Spectrum Disorders: Four Experimental Case Series
Hella Janssen, K.C. van den Berg, Ger P. J. Keijsers, Geòrgie Paulik, Katherine Newman‐Taylor, Christopher D. J. Taylor, Craig Steel, Machteld Marcelis
Schizophrenia Bulletin February 21, 2025 DOI: 10.1093/schbul/sbaf033 (opens in new tab) via OpenAlex
Summary
AI-generated from the abstractIn people with psychosis spectrum disorders, maladaptive mental imagery is linked to auditory verbal hallucinations (AVHs). Four imagery techniques were tested in a single-case series: Imagery Rescripting (ImRs), Promoting positive Imagery de novo (Pos-Im), Metacognitive Imagery techniques (Meta-Im), and playing Tetris. Mental imagery severity significantly decreased after ImRs and Pos-Im, but not after Meta-Im or Tetris. AVHs decreased with all conditions, with the largest effects for ImRs and Pos-Im. Secondary measures showed reductions in AVH severity, mood, anxiety, imagery frequency, and appraisals. The authors conclude imagery techniques are feasible and acceptable and may be valuable additions to AVH treatment.
Study at a glance
| Characteristics | Replicated single-case series experimental design Randomized Case report Peer reviewed |
|---|---|
| Sample size | 28 |
| Population | Participants with psychosis spectrum disorders and auditory verbal hallucinations |
| Interventions | Imagery Rescripting Promoting positive Imagery de novo Metacognitive Imagery techniques Tetris |
| Duration | 2-week baseline, 3 weeks of therapy, 2-week follow-up |
| Topics | Anxiety |
| Keywords | Psychosis Mood Mental image Clinical psychology Social anxiety |
| Citations | 2 |
| Key finding | Mental imagery severity decreased after Imagery Rescripting and Promoting positive Imagery de novo; auditory verbal hallucinations decreased with all four conditions, with largest effects for those two techniques. |
Abstract
BACKGROUND: In psychosis spectrum disorders, maladaptive mental imagery is associated with auditory verbal hallucinations (AVHs). This study evaluates the feasibility, acceptability, and effectiveness of the following 4 imagery techniques in targeting mental imagery and AVHs severity: Imagery Rescripting (ImRs), Promoting positive Imagery de novo (Pos-Im), Metacognitive Imagery techniques (Meta-Im), and playing Tetris. STUDY DESIGN: Four replicated single-case series experimental designs were used. Participants were randomized to 1 of the 4 treatment conditions. Primary, we measured the severity of mental imagery and AVHs thrice daily on an 11-point VAS scale during a 2-week baseline, throughout 3 weeks of therapy, and during a 2-week follow-up phase. Randomization tests were used to examine whether daily severity levels of momentary mental imagery and AVHs decreased post-therapy. Secondary, questionnaires assessing the severity of AVHs, mental imagery characteristics, and levels of mood, anxiety, and functioning were administered at baseline, before, and posttreatment. RESULTS: Twenty-eight participants completed all treatment sessions. Mental imagery significantly decreased after ImRs (P < .001, d = 1.13) and Pos-Im (P = .039, d = 0.22), with no significant effects observed following Meta-Im or Tetris. AVHs significantly decreased with all treatment conditions, with largest effects for ImRs (P = .001, d = 1.39) and Pos-Im (P < .001, d = 1.99). Secondary results demonstrated reductions in the severity of AVHs, mood, anxiety, imagery frequency, and appraisals. CONCLUSIONS: Imagery techniques appear feasible and acceptable for addressing mental imagery and AVHs in the psychosis continuum and may be valuable additions to current treatment for AVHs.