Abstract
Background: Auditory hallucinations (voices) in people with a diagnosis of borderline personality disorder (BPD) have traditionally been regarded as ‘pseudohallucinations’. However, recent research suggests that these voice hearing experiences can be highly distressing and share many of the same qualities as those found in diagnoses such as schizophrenia. Given these similarities, can any psychological therapies effectively treat distressing voices in the context of a BPD diagnosis? Aim: To add to the growing literature exploring voice-related distress in people with a diagnosis of BPD and to answer the unique question of whether brief psychological therapy is effective at reducing voice-related distress for people with a diagnosis of BPD. Methods: 37 people with a diagnosis of BPD and 49 with a diagnosis of schizophrenia received up to four sessions of Coping Strategy Enhancement therapy. The primary outcome measure at baseline and post intervention was the distress subscale of the Psychotic Symptoms Rating Scales (PSYRATS). The frequency, attribution and loudness subscales of the PSYRATS, the Depression Anxiety and Stress Scales (DASS21), the CHoice of Outcome in Cbt for PsychosEs (CHOICE), the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) and drop-out rates were secondary measures. Results: The BPD group reported significantly greater voice-related distress at baseline. The BPD group, but not the schizophrenia group, reported statistically significant improvements on voice-related distress at post-therapy. Only a small minority of participants (BPD = 15% and schizophrenia = 16.7%) showed reliable improvements in voice-related distress, with this not differing significantly between the groups. When controlling for baseline distress and other covariates, the BPD group reported statistically greater improvement in voice-related distress than the schizophrenia group. Withdrawal rates were low for both groups. When controlling for covariates, the attribution dimension of the PSYRATS, the stress subscale of the DASS21, and well-being were the only secondary measures that was predicted by diagnosis. Conclusion: Voices can be experienced as highly distressing for people with a diagnosis of BPD. Brief psychological therapy appears to be appropriate for helping people who experience distressing voices to engage with therapy as part of a stepped-care process, but it is unlikely to produce reliable and clinically meaningful improvements as a standalone treatment.