5 - (IOP 2) Command Auditory Verbal Hallucinations in an Early Intervention Service: Prevalence, Content, and Predictors in a Large Culturally Diverse Population - Implications for Early Intervention Cbtp

Command auditory verbal hallucinations (CAVH) are associated with harmful behaviours such as deliberate self-harm and violence toward others (Hazell et al., 2024). The content of these auditory hallucinations appears to play a crucial role in their clinical significance (Larøi, 2019) and in influencing harmful compliance (e.g., Junginger, 1995). However, research on CAVH prevalence, content, and predictors in early-course psychosis remains limited, particularly in religiously and culturally diverse patient populations.

This registered Quality Improvement project is a collaboration between the National Health Service and academia (University College London), aimed to provide ecologically valid local data in order to train staff in the personalization of clinical care for psychoeducation and CBT. We conducted a case note survey of the health records of auditory verbal hallucination hearers (n = 740; CAVH hearers = 376 (50.8%); non-CAVH hearers = 364 (49.2%)). The sample was exceptionally culturally diverse (16 religions and 27 ethnicities) and young (M = 25.2 years, SD = 5.2 years), had a short duration of untreated psychosis of (M = 1.4 months, SD = 2.9 months), and a short psychosis illness length (M = 23.4 months, SD = 10.0 months).

CAVH content was defined based on either the content of the voice itself or the patient's belief that the voice conveyed a command (Braham et al., 2004). Command content was categorized using predefined, clinically relevant classifications (e.g., the intended target of the harm-related command). The prevalence of each content feature was then calculated (N, %). To identify predictors of command presence, AVH patients with CAVH were compared to those without CAVH based on selected sample characteristics (e.g., duration of untreated psychosis, psychosis illness length); univariate analyses and logistic regression were employed.

Our survey is by far the largest and most culturally diverse survey of CAVH in early-course psychosis. It illuminates CAVH prevalence (50.8% in the first two years), identifying key clinical features such as who receives commands, when they emerge, and the impact of early intervention speed on CH presence.

Theoretical contributions include embellishments to cognitive models of voice-hearing and the development of a theoretical framework to guide early intervention-focused CBT. These findings will support the advancement of CBT into precision-targeted CBT for psychosis (Newman-Taylor & Bentall, 2024), aiming to reduce distress and harmful compliance while enhancing the cultural competence of mental health professionals.
This project advances cognitive-behavioural science and the NHS by contributing a large amount of new empirical data about a serious public health problem that CBT can potentially ameliorate.