The effect of trauma‐focused therapy on voice‐hearing: An experience sampling study

Simone R. Burger; Amy Hardy; Inez Verdaasdonk; Berber van der Vleugel; Philippe Delespaul; Catherine van Zelst; Paul A. J. de Bont; Anton B. P. Staring; Carlijn de Roos; Ad de Jongh; Machteld Marcelis; Agnes van Minnen; Mark van der Gaag; David van den Berg

doi:10.1111/papt.12556

The effect of trauma‐focused therapy on voice‐hearing: An experience sampling study

Simone R. Burger
, Amy Hardy
, Inez Verdaasdonk
, Berber van der Vleugel
, Philippe Delespaul
, Catherine van Zelst
, Paul A. J. de Bont
, Anton B. P. Staring
, Carlijn de Roos
, Ad de Jongh
, Machteld Marcelis
, Agnes van Minnen
, Mark van der Gaag
, David van den Berg

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

Trauma and post-traumatic stress are involved in the aetiology and maintenance of voice-hearing. It has been proposed that trauma-focused therapy (TFT) might affect voice-hearing, but previous studies are limited and remain undecided.

Objectives
We aimed to investigate the effect of TFT on voice-hearing in people with PTSD and psychosis using experience sampling method (ESM). A secondary aim was to explore how changes in voice-hearing are related to changes in PTSD.

Design
This is an adjunct longitudinal ESM study of a sub-group of participants (N = 39) from a randomised controlled trial that compared TFT to a waiting-list control group.

Methods
Voice-hearing participants filled in 10 daily voice-hearing-related questionnaires for six consecutive days at baseline and post-treatment at pseudo-random times during the day. PTSD symptom severity was assessed at baseline and post-treatment. Multilevel linear regression was used to test the effect of TFT on voice-hearing and to analyse the relationship between changes in voice-hearing and changes in PTSD.

Results
The intention-to-treat analysis showed a significant interaction effect between time and treatment condition (p < .00001) with a small effect size (dppc2 = −0.27), indicating a larger decrease in voice-hearing in the TFT group than in the waiting-list control group. Also, a significant association was observed between changes in PTSD symptoms and changes in voice-hearing (p < .00001).

Conclusions
Our findings tentatively suggest that, even when voices are not targeted directly, TFT for PTSD can alleviate distressing voices.

Original language	English
Pages (from-to)	25-39
Number of pages	15
Journal	Psychology and Psychotherapy: Theory, Research and Practice
Volume	98
Issue number	1
Early online date	4 Nov 2024
DOIs	https://doi.org/10.1111/papt.12556
Publication status	Published - Mar 2025

Funding

The authors wish to thank the participants, therapists, research assistants and all others who contributed to this study. This research was supported by a grant awarded to Mark van der Gaag and David van den Berg by the Dutch Support Foundation Stichting tot Steun VCVGZ. Amy Hardy was funded in part by the NIHR Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. These funding organisations had no part in the design or administration of the study or decisions about this report.

Funders
Dutch Support Foundation Stichting tot Steun VCVGZ
NIHR Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust
King's College London

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Burger, S. R., Hardy, A., Verdaasdonk, I., Vleugel, B. V. D., Delespaul, P., Zelst, C. V., Bont, P. A. J. D., Staring, A. B. P., Roos, C. D., Jongh, A. D., Marcelis, M., Minnen, A. V., Gaag, M. V. D., & Berg, D. V. D. (2025). The effect of trauma‐focused therapy on voice‐hearing: An experience sampling study. Psychology and Psychotherapy: Theory, Research and Practice, 98(1), 25-39. https://doi.org/10.1111/papt.12556

@article{aa04ef3f97db4f1eb734c9c91d0e099e,

title = "The effect of trauma‐focused therapy on voice‐hearing: An experience sampling study",

abstract = "Trauma and post-traumatic stress are involved in the aetiology and maintenance of voice-hearing. It has been proposed that trauma-focused therapy (TFT) might affect voice-hearing, but previous studies are limited and remain undecided. Objectives We aimed to investigate the effect of TFT on voice-hearing in people with PTSD and psychosis using experience sampling method (ESM). A secondary aim was to explore how changes in voice-hearing are related to changes in PTSD. Design This is an adjunct longitudinal ESM study of a sub-group of participants (N = 39) from a randomised controlled trial that compared TFT to a waiting-list control group. Methods Voice-hearing participants filled in 10 daily voice-hearing-related questionnaires for six consecutive days at baseline and post-treatment at pseudo-random times during the day. PTSD symptom severity was assessed at baseline and post-treatment. Multilevel linear regression was used to test the effect of TFT on voice-hearing and to analyse the relationship between changes in voice-hearing and changes in PTSD. Results The intention-to-treat analysis showed a significant interaction effect between time and treatment condition (p < .00001) with a small effect size (dppc2 = −0.27), indicating a larger decrease in voice-hearing in the TFT group than in the waiting-list control group. Also, a significant association was observed between changes in PTSD symptoms and changes in voice-hearing (p < .00001). Conclusions Our findings tentatively suggest that, even when voices are not targeted directly, TFT for PTSD can alleviate distressing voices. ",

author = "Burger, \{Simone R.\} and Amy Hardy and Inez Verdaasdonk and Vleugel, \{Berber van der\} and Philippe Delespaul and Zelst, \{Catherine van\} and Bont, \{Paul A. J. de\} and Staring, \{Anton B. P.\} and Roos, \{Carlijn de\} and Jongh, \{Ad de\} and Machteld Marcelis and Minnen, \{Agnes van\} and Gaag, \{Mark van der\} and Berg, \{David van den\}",

year = "2025",

month = mar,

doi = "10.1111/papt.12556",

language = "English",

volume = "98",

pages = "25--39",

journal = "Psychology and Psychotherapy: Theory, Research and Practice",

issn = "1476-0835",

publisher = "Wiley-Blackwell",

number = "1",

}

Burger, SR, Hardy, A, Verdaasdonk, I, Vleugel, BVD, Delespaul, P, Zelst, CV, Bont, PAJD, Staring, ABP, Roos, CD, Jongh, AD, Marcelis, M, Minnen, AV, Gaag, MVD & Berg, DVD 2025, 'The effect of trauma‐focused therapy on voice‐hearing: An experience sampling study', Psychology and Psychotherapy: Theory, Research and Practice, vol. 98, no. 1, pp. 25-39. https://doi.org/10.1111/papt.12556

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AU - Burger, Simone R.

AU - Hardy, Amy

AU - Verdaasdonk, Inez

AU - Vleugel, Berber van der

AU - Delespaul, Philippe

AU - Zelst, Catherine van

AU - Bont, Paul A. J. de

AU - Staring, Anton B. P.

AU - Roos, Carlijn de

AU - Jongh, Ad de

AU - Marcelis, Machteld

AU - Minnen, Agnes van

AU - Gaag, Mark van der

AU - Berg, David van den

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N2 - Trauma and post-traumatic stress are involved in the aetiology and maintenance of voice-hearing. It has been proposed that trauma-focused therapy (TFT) might affect voice-hearing, but previous studies are limited and remain undecided. Objectives We aimed to investigate the effect of TFT on voice-hearing in people with PTSD and psychosis using experience sampling method (ESM). A secondary aim was to explore how changes in voice-hearing are related to changes in PTSD. Design This is an adjunct longitudinal ESM study of a sub-group of participants (N = 39) from a randomised controlled trial that compared TFT to a waiting-list control group. Methods Voice-hearing participants filled in 10 daily voice-hearing-related questionnaires for six consecutive days at baseline and post-treatment at pseudo-random times during the day. PTSD symptom severity was assessed at baseline and post-treatment. Multilevel linear regression was used to test the effect of TFT on voice-hearing and to analyse the relationship between changes in voice-hearing and changes in PTSD. Results The intention-to-treat analysis showed a significant interaction effect between time and treatment condition (p < .00001) with a small effect size (dppc2 = −0.27), indicating a larger decrease in voice-hearing in the TFT group than in the waiting-list control group. Also, a significant association was observed between changes in PTSD symptoms and changes in voice-hearing (p < .00001). Conclusions Our findings tentatively suggest that, even when voices are not targeted directly, TFT for PTSD can alleviate distressing voices.

AB - Trauma and post-traumatic stress are involved in the aetiology and maintenance of voice-hearing. It has been proposed that trauma-focused therapy (TFT) might affect voice-hearing, but previous studies are limited and remain undecided. Objectives We aimed to investigate the effect of TFT on voice-hearing in people with PTSD and psychosis using experience sampling method (ESM). A secondary aim was to explore how changes in voice-hearing are related to changes in PTSD. Design This is an adjunct longitudinal ESM study of a sub-group of participants (N = 39) from a randomised controlled trial that compared TFT to a waiting-list control group. Methods Voice-hearing participants filled in 10 daily voice-hearing-related questionnaires for six consecutive days at baseline and post-treatment at pseudo-random times during the day. PTSD symptom severity was assessed at baseline and post-treatment. Multilevel linear regression was used to test the effect of TFT on voice-hearing and to analyse the relationship between changes in voice-hearing and changes in PTSD. Results The intention-to-treat analysis showed a significant interaction effect between time and treatment condition (p < .00001) with a small effect size (dppc2 = −0.27), indicating a larger decrease in voice-hearing in the TFT group than in the waiting-list control group. Also, a significant association was observed between changes in PTSD symptoms and changes in voice-hearing (p < .00001). Conclusions Our findings tentatively suggest that, even when voices are not targeted directly, TFT for PTSD can alleviate distressing voices.

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The effect of trauma‐focused therapy on voice‐hearing: An experience sampling study

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