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Coversheet for Thesis in Sussex Research Online A University of Sussex PhD thesis Available online via Sussex Research Online: http://sro.sussex.ac.uk/ This thesis is protected by copyright which belongs to the author. This thesis cannot be reproduced or quoted extensively from without first obtaining permission in writing from the Author The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the Author When referring to this work, full bibliographic details including the author, title, awarding institution and date of the thesis must be given Please visit Sussex Research Online for more information and further details Is 16 the Magic Number? Guided self-help CBT intervention for Voices Evaluated (GiVE). Cassie M Hazell Thesis submitted for the degree of Doctor of Philosophy School of Psychology University of Sussex April 2017 1 Statement: I hereby declare that this thesis has not been and will not be submitted in whole or in part to another University for the award of any other degree. Cassie M Hazell 28th April 2017 Declaration: The thesis conforms to an ‘article format’ in which the middle chapters consist of discrete articles written in a style that is appropriate for publication in peer-reviewed journals in the field. Chapters one, two, three, four, five, and eleven present synthetic overviews and discussions of the field and the research undertaken. 2 Acknowledgements. I would like to thank Dr Clara Strauss, Dr Mark Hayward and Dr Kate Cavanagh for their guidance and insight throughout my PhD. I have learnt a lot from each of you, and have appreciated and enjoyed the opportunity to work with each of you over these three years. Thank you for your faith in me, and faith in this project. It has been wonderful to be part of a team that is truly dedicated to improving the lives of people with mental health difficulties. Your passion, honesty, and support has helped me to develop as a researcher. Thank you to Sussex Partnership NHS Foundation Trust and the Economic and Social Research Council (ESRC) for funding this PhD; and thank you to the University of Sussex for sponsoring my research, and providing me with the opportunity to be more than was ever expected of me. I will be forever in debt (financially, and emotionally) to this institution. I would like to thank the team at the Sussex Partnership NHS Foundation Trust research and development department, especially Adam Baxter, Serena Gregory, Taffy Bakasa, and Yvette Wagner. Your help navigating the clinical research process has been invaluable. A further thank you goes to the GiVE research team. Thank you to the trial therapists for your flexibility and commitment to the project: Dr Mark Hayward, Dr Clara Strauss, Dr Kathy Greenwood, Emily Ironmonger, Dan Stevens, Angela Hillemann, and Danielle Phoenix; with special thanks to Dr Sam Fraser, Dr Kat Pugh and Charlotte Wilcox for taking more than your share of clients. Thank you to Anna-Marie Jones for your genius statistics knowhow, and, more recently, your honest career advice. You have reminded me of the bigger picture, and made me believe it is all possible. To Leanne Bogen-Johnston, thank you for your work as the GiVE research assistant. You were a huge source of support for me when I first joined the department as a research assistant – Sussex are lucky to have you. I hope this will not be the last time we work together. Thank you to all of the people that have participated in the studies within this thesis – especially those distressed by hearing voices. Your ability to be open and warm in the face of personal adversity was humbling. For the same reasons, thank you to Hearing Voices Brighton. I am so glad we found each other. Being part of the HVB community has helped me to rememberwhy I got into research in the first place, and open my eyes to the alternative. On a more personal level, I want to thank the best office mates a girl could ask for. Gracias, mulțumesc, Благодаря, and 謝謝 to James, Vlad, Petar, and Sheng. You have all taught me so much. For example, I am now able to say, with reasonable confidence, “no I don’t want a cup of tea” in each of your native tongues. I am genuinely saddened at the thought of 3 leaving 1C1 and not seeing you all every day. You have managed to keep a smile on my face throughout the final and most demanding year of my PhD. Finally I would like to thank my amazing family. To my Thomas, my partner in crime, my forest boy. You know I am not very good at the ‘lovey dovey’ stuff, so make the most of this... Who knew a chance meeting on the first day of university with some tall, fuzzy haired man in jeans that were too short for him would change my life? It was hardly love at first sight, but over time our friendship became so much more. Thank you for supporting me and my aspirations – you have always believed in me, even when I didn’t believe in myself. We have been through so much together, and grown together. Thank you for holding my hand throughout this PhD – please don't ever let go. To my grandparents – you were such generous people. You never let me forget that I was loved. It breaks my heart that grandad - you are not here to see this, and that nan - you won’t remember this. I will always be your princess. To my lil bro, Teddy Babes, you have always been able to make me laugh. Thank you for my beautiful niece – Holly is beautiful, and I cannot wait to watch her grow in the years to come. In recent years you have taught me that there is always time to make a change, and the possibilities that can come from being strong minded. You are at times irritating beyond words, but I must begrudgingly admit that I wouldn’t change you for the world. You keep me grounded, and our heart-to-hearts mean more to me than you will ever know. Cheers breh. Thank you to both of my parents for always encouraging me to aim high, and just ‘do my best’. I know you both were worried about me going to university but I am grateful that you have always supported me regardless. To my papa bear. Thank you for teaching me the value of hard work and perseverance. I am proud to call you dad, and I hope that I can make you proud too. You are the most selfless man I know, and have always put our needs before yours. You have worked yourself to exhaustion at times to make sure that we never went without – I will never be able to put into words how much that means to me. I love you lots daddy. You are my hero – always ready to come to my rescue. To my mum, and my best friend. I honestly don’t know what I would do without you. You are always just a phone call away, ready to listen to me, even if you don’t understand what I am on about. You taught me from an early age the value of education and the opportunities that it can give you, for that I cannot thank you enough. The strength I have seen in you, especially over these past few years, has taught me to never stop fighting. You are the bravest 4 person I know, and I hope one day I will be just like you. I love you momma bear – all the monies in the world. To my family - I dedicate this to you. 5 Summary. Hearing distressing voices (also known as auditory verbal hallucinations) is a common symptom associated with a number of mental health problems. Psychological therapies, specifically cognitive behaviour therapy (CBT) can be an effective intervention for this patient group. The aim of CBT for voices (CBTv) is to reduce the distress associated with the experience, by encouraging the patient to re-evaluate their beliefs about the voice’s omnipotence, omniscience, and malevolence. Despite the evidence for CBTv, very few patients are offered this therapy; largely due to a lack of resources. The aim of this thesis was to develop and begin to evaluate a CBT-based intervention for voices that was resource-light; in the hope that it could be more easily be implemented into clinical services, and therefore increase access. This thesis begins with an introduction to the research area, and is followed by a review and evaluation of the methods used in this thesis. Chapter 6 is a systematic review and meta- analysis of the current literature on brief (<16 NICE recommended sessions) CBT for psychosis (CBTp). Chapters 7 and 8 describe the process of developing a brief CBT intervention for voices, based on the CBT self-help book ‘Overcoming Distressing Voices’. Both people who hear voices, and mental health clinicians were consulted on the intervention concept and design. The outcome of these studies was guided self-help CBTv, and an accompanying therapy workbook to guide the intervention. Chapters 9 and 10 detail the design and findings of a randomised controlled trial of guided self-help CBTv delivered by Clinical Psychologists, versus a wait-list control group. Data was collected at baseline (pre-randomisation) and 12 weeks post-randomisation. The primary outcome was voice-related distress. The findings across all of the studies are then summarised and reflected upon within the Discussion chapter – including consideration of the extent to which the overall aim of this thesis (increasing access) has been achieved.
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