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The COMMAND trial of cognitive therapy to prevent harmful compliance with command hallucinations : predictors of outcome and mediators of change
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Birchwood, M. J., Dunn, Graham, Meaden, Alan, Tarrier, Nicholas, Lewis, Shon, Wykes, Til, Davies, Linda (Linda M.), Michail, Maria and Petes, Emmanuelle (2017) The COMMAND trial of cognitive therapy to prevent harmful compliance with command hallucinations : predictors of outcome and mediators of change. Psychological Medicine, 48 (12). pp. 1966-1974. doi:10.1017/S0033291717003488 ISSN 0033-2917.
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Official URL: https://doi.org/10.1017/S0033291717003488
Abstract
Background
Acting on harmful command hallucinations is a major clinical concern. Our COMMAND CBT trial approximately halved the rate of harmful compliance (OR = 0.45, 95% CI 0.23–0.88, p = 0.021). The focus of the therapy was a single mechanism, the power dimension of voice appraisal, was also significantly reduced. We hypothesised that voice power differential (between voice and voice hearer) was the mediator of the treatment effect.
Methods
The trial sample (n = 197) was used. A logistic regression model predicting 18-month compliance was used to identify predictors, and an exploratory principal component analysis (PCA) of baseline variables used as potential predictors (confounders) in their own right. Stata's paramed command used to obtain estimates of the direct, indirect and total effects of treatment.
Results
Voice omnipotence was the best predictor although the PCA identified a highly predictive cognitive-affective dimension comprising: voices’ power, childhood trauma, depression and self-harm. In the mediation analysis, the indirect effect of treatment was fully explained by its effect on the hypothesised mediator: voice power differential.
Conclusion
Voice power and treatment allocation were the best predictors of harmful compliance up to 18 months; post-treatment, voice power differential measured at nine months was the mediator of the effect of treatment on compliance at 18 months.
| Item Type: | Journal Article | |||||||||
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| Subjects: | R Medicine > RC Internal medicine | |||||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Mental Health and Wellbeing Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Auditory hallucinations., Schizophrenia -- Treatment, Cognitive therapy., Hallucinations and illusions., Psychosis. | |||||||||
| Journal or Publication Title: | Psychological Medicine | |||||||||
| Publisher: | Cambridge University Press | |||||||||
| ISSN: | 0033-2917 | |||||||||
| Official Date: | 5 December 2017 | |||||||||
| Dates: |
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| Volume: | 48 | |||||||||
| Number: | 12 | |||||||||
| Page Range: | pp. 1966-1974 | |||||||||
| DOI: | 10.1017/S0033291717003488 | |||||||||
| Status: | Peer Reviewed | |||||||||
| Publication Status: | Published | |||||||||
| Access rights to Published version: | Open Access (Creative Commons) | |||||||||
| Date of first compliant deposit: | 13 November 2017 | |||||||||
| Date of first compliant Open Access: | 19 September 2018 | |||||||||
| RIOXX Funder/Project Grant: |
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