RIJAL MAULA

1414201063
S1 KEPERAWATAN 7B
INTERVENTIONS OF AUDITORY HALLUCINATIONS

AUDITORY HALLUCINATIONS (AHs) are a distressing experience and have been

associated with anxiety, depression (Hustig & Hafner, 1990), and suicidal behavior (Falloon &
Talbot, 1981). The more patients described AHs as distressing and intrusive, the more anxious
and depressed they were (Hustig & Hafner, 1990). Even with the development of new drugs, a
great number of people with schizophre- nia continue to suffer from AHs (American Psychiatric
Association [APA], 2004; Asarnow & MacCrimmon, 1982; Falloon & Talbot, 1981).

Orem (1985) noted that human beings have the potential to develop their intellectual and
practical skills and the motivation essential for self-care. The ways that individuals meet self-
care needs are influenced by personal and cultural elements. Indeed, self-care management
strategies have been reported to decrease or relieve the disturbance of AHs among patients
(Allen, Halperin, & Friend, 1985; Falloon & Talbot, 1981; Feder, 1982; Frederick & Cotanch,
1995; Slade, 1972; Tarrier, 1987). Earlier case studies have described talking with someone
(Slade, 1972), listening to a relaxation tape (Slade, 1972), listening to music (Feder, 1982), and
saying bstopQ and substituting other thoughts (Allen et al., 1985) as effective strategies for
reducing AHs. Other self-care management strategies for AHs have been identified in several
descriptive studies. Western studies have found that patients frequently used pacing (Falloon &
Talbot, 1981), jogging (Falloon & Talbot, 1981; Frederick & Cotanch, 1995), walking (Frederick
& Cotanch, 1995), eating (Falloon & Talbot, 1981), drinking alcohol (Falloon & Talbot, 1981;
Tarrier, 1987), telephoning friends.

A study in Taiwan (Lee & Tsai, 2003) found that only 67 of 102 outpatients with
schizophrenia reported using self-management strategies to deal with AHs. These patients
commonly used ignoring AHs, listening to music, watching television, and talking to others.
Recently, more patients with schizophrenia (including outpatients, day care patients, and
inpatients) in general hospitals were recruited in Taiwan and their strategies to self- manage AHs
were identified (Tsai & Chen, in review). Among these 41 self-management strat- egies, the
most frequently used were listening to music and engaging in activities to shift attention. That
study also found that the patients most frequently used behavioral change strategies and self-
learning as a resource.

DISCUSSION

The Development of Psychological Therapies for Voices The development of

psychological therapies for voices has primarily involved the application of behavioral and
cognitive-behavioral methods with persons with psychotic disorders. Early studies adopted
behavioral approaches, based upon addressing hypothesized ante- cedents and reinforcers of
voices. These studies examined a range of specific interventions such as relaxation train- ing,
graded exposure to voice triggers, manipulation of environmental contingencies for behavioral
responding to voices, and even aversion therapy.11 Other studies, spurred by research into
coping in psychosis, examined training in specific coping methods, in particular manipulation of
sensory input using ear plugs or music on headphones and use of distraction techniques, with
some evidence of effectiveness (see review by Farhall et al12). Integrating a number of these
methods into a func- tional analysis-based approach, the development of coping strategy
enhancement (CSE)13 in the early 1990s provided a precursor to formulation-based cognitive-
behavioral interventions used today. In CSE, a detailed assessment of modulating factors and
responses to voices is used to inform individually tailored modifications to the person’s chosen
coping methods. In 2 trials of people with schizophrenia with hallucinations or delusions, CSE
resulted in reduced ratings of symptom severity, com- pared with both treatment as usual (TAU)
and supportive counseling.

CONCLUSSION

RCT data for the use of CBTp in schizophrenia sup- ports the idea that including
psychological therapy in addition to routine care is more beneficial than routine care alone on
participants’ report of psychotic symp- tom severity, with very recent data suggesting that this
extends to measures of overall voice severity. However, closer examination of the data relating
specifically to voices suggests that our understanding of which specific methods are useful for
promoting expected outcomes for voices as a specific treatment target remains limited. To
address this, we may need to graduate from the focus on whether broad therapy approaches such
as CBTp dem- onstrate effects on generic symptom outcomes onto more targeted research to
better understand specific processes, therapeutic methods, and applicability for different voice
hearers and service delivery contexts.