A grounded theory study exploring change processes following cognitive behavioural therapy for distressing voices

Rationale: Cognitive Behavioural Therapy for voice hearing (CBTv) has been shown to be effective at reducing distress and improving functioning. However, it is unclear why voice hearers might deteriorate or continue to benefit post-intervention.

Objectives: This study aimed to explore the therapeutic change process following CBTv.

Methodology: A critical realist, grounded theory methodology was utilised. Individual interviews were conducted with 12 participants who had experienced distressing voice hearing and had completed a CBTv intervention in the last 3-12 months. Participants were recruited from a specialist hearing voices service.

Results: Three categories were found to be facilitative of positive change within CBTv: ‘New Ways of Managing’, ‘Overcoming Challenges’ and ‘Gaining New Perspectives’. Five categories supported the maintenance or furthering of positive change following intervention. These were ‘Having a Sense of Control’, ‘Standing on My Own Two Feet’, ‘Voices Are Just Part of My Life’, ‘Investing in Sustaining Relationships’, and ‘Rediscovering and Developing Identity’. Challenging circumstances were also faced by participants and are incorporated into a model for maintaining change following CBTv.

Conclusions: The model adds to current literature on change processes occurring with CBTv and the maintenance of change following a psychological intervention. The results support the need for those working with voice hearers post therapy to focus on rebuilding social relationships, meaning making and identity.