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

BackgroundCognitive Behavioural Therapy for voice hearing (CBTv) has been shown to be effective at reducing distress. However, it is unclear why voice hearers might deteriorate or continue to benefit post-intervention. This study aimed to explore therapeutic change processes following CBTv.MethodsA 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.ResultsThree categories were found to be facilitative of positive change within CBTv: “New Ways of Managing”, “Overcoming Challenges” and “Gaining New Perspectives”. Five categories denoted the maintenance or furthering of positive change following intervention: “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 faced by participants are also incorporated into a model for maintaining change following CBTv.DiscussionThe model adds to current literature on change processes occurring within and after CBTv. The results support the need for those working with voice hearers post-therapy to focus on rebuilding social relationships, meaning making and identity.