TY - JOUR
PY - 2018//
TI - The COMMAND trial of cognitive therapy to prevent harmful compliance with command hallucinations: predictors of outcome and mediators of change
JO - Psychological medicine
A1 - Birchwood, Max
A1 - Dunn, Graham
A1 - Meaden, Alan
A1 - Tarrier, Nicholas
A1 - Lewis, Shôn
A1 - Wykes, Til
A1 - Davies, Linda
A1 - Michail, Maria
A1 - Peters, Emmanuelle
SP - 1966
EP - 1974
VL - 48
IS - 12
N2 - 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.
Language: en
LA - en SN - 0033-2917 UR - http://dx.doi.org/10.1017/S0033291717003488 ID - ref1 ER -