Hearing voices simulation: process and outcomes of training

Publication Date08 Apr 2014
AuthorSue Patterson,Nicole Goulter,Tim Weaver
SubjectHealth & social care,Mental health,Mental health education
Hearing voices simulation: process and
outcomes of training
Sue Patterson, Nicole Goulter and Tim Weaver
Dr Sue Patterson is a Principal
Research Fellow, and Nicole
Goulter is a Clinical Academic
Fellow, both are based at
Department of Mental Health,
Metro North Hospital and
Health Service District,
Brisbane, Australia.
Dr Tim Weaver is a Senior
Lecturer, based at Centre for
Mental Health, Imperial College
London, London, UK.
Purpose – The purpose of this paper is to examine the experience and impact of targeted training involving
simulation of auditory hallucinations on attitudes and practice of professionals working with people with
mental illness.
Design/methodology/approach – Pragmatic mixed-method study. Data were collected from 83
professionals who completed training using cross-sectional survey and focus groups. Descriptive,
comparative and thematic analyses were performed.
Findings – Training was associated with changes in thinking and attitude related to working with people
who hear voices. Participants, who commonly found the simulation confronting, drew on the experience to
deepen appreciation of coping with voices that are distressing and develop a new frame of reference for
practice. They positioned themselves differently and described adopting a range of practices consistent
with the recovery approach. Environmental constraints variously impacted on capacity to enact these
Research limitations/implications – The study was conducted in one centre using a bespoke survey
instrument with a sample intrinsically motivated to complete training. Hence, caution should be exercised
with regard to generalisability.However, findings are consistent with the limited published literature and the
mixed-method approach provided a comprehensive understanding.
Practical implications – The paper demonstrated that the training employed can support development of
patient centred, recovery-oriented practices. These are likely essential to optimising patient and service
outcomes. Further research is needed to examine the impact of training on a broader cross section of
professionals and the outcomes for patients.
Originality/value – The paper provides important new insights regarding the mechanisms by which
training can contribute to development of patient-centred care.
Keywords Attitudes, Training, Mixed methods, Simulation, Focus groups, Auditory hallucinations
Paper type Research paper
These are turbulent times in health care: providers are challenged to simultaneously optimise
efficiency, effectiveness and patient experience. The (often implicit) assumption that knowledge
and skill gaps and “inappropriate” attitudes impede delivery of best practice care supports
substantial investment in professional development and training activities. Some activities (e.g.
in time management or shared decision making) are generic, relevant across professional
practice, others are designed to improve practice in a given domain. The training subject to
evaluation in this study is an example of the latter, designed to improve care for people with
mental illness (MI) who experience auditory hallucinations.
Auditory hallucinations – noises and voices “heard” in the absence of corresponding external
stimuli, whilst not pathognomonic for MI are common in schizophrenia, post-traumatic stress
disorder and bi-polar affective disorder (Waters, 2010) and often persist when medication
is otherwise helpful. Various psychosocial interventions, including group-based CBT
The authors are grateful to all those
who have contributed to successful
completion of this study including
workshop facilitators and trainees.
To those who made time to
participate in the survey and/or
focus groups and shared
generously of their experience, the
authors trust that they have
represented their voice fairly. This
work was conducted without
dedicated funding. N.G. and S.P.
completed the work during
employment by Metro North
Hospital and Health Services and
acknowledge the in-kind support of
the organisation. T.W.was
employed by Imperial College
London and contributed his
expertise voluntarily. Special thanks
to Peter Bullimore for his
contribution to the training and
allowing the authors to cite his
work. The authors also thank
Jeremy Johnson for his helpful
comments during preparation of
the manuscript. The authors
declare that they have no
conflicting interests.
VOL. 9 NO. 1 2014, pp. 46-58, CEmerald Group Publishing Limited, ISSN 1755-6228 DOI 10.1108/JMHTEP-01-2013-0003

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