Les TCC sont reconnues comme un moyen efficace de lutter contre les hallucinations auditives présentes dans les schizophrénies résistantes. Cependant, il existe peu d’études regroupant les avancées faites sur ce sujet. Cette revue de littérature propose une analyse comparative de plusieurs études portant sur les effets des TCC ciblant les hallucinations auditives chez les patients souffrant de schizophrénie. Elle permet de mieux appréhender les bénéfices et les limites de ces thérapies dans un cadre individuel et en groupe.

Les publications ont été sélectionnées en utilisant la base de données de l’US National Library of médicine avec les mots clés « cognitive therapy », « behavioural therapy », « schizophrenia », « hallucinations », « voices ». Les études retenues ont été réparties en 2 catégories : les thérapies individuelles et les thérapies de groupe. Pour chacune des thérapies employées, on a comparé l’effectif de la population étudiée, le diagnostic d’inclusion, les échelles dévaluation utilisées, le type de thérapie expérimentée, la durée de traitement et de suivi, les résultats observés.

Il existe des effets bénéfiques des thérapies cognitives et comportementales chez les patients schizophrènes souffrant d’hallucinations auditives, que ce soit en groupe ou en thérapie individuelle. Ces effets concernent principalement la charge anxieuse, l’intensité et la fréquence des hallucinations. Certains protocoles thérapeutiques ont permis une amélioration de l’insight et de l’estime de soi.

Les TCC individuelles pourraient être indiquées chez des patients pour qui les symptômes négatifs sont peu envahissants ou lorsque les habiletés sociales sont trop altérées pour permettre l’intégration dans un groupe. Les TCC de groupe s’intégreraient mieux dans une prise en charge de type hôpital de jour. L’ensemble des résultats observés sont à nuancer compte tenu de la faible puissance statistique des études. De plus, les paramètres analysés sont très nombreux et différents suivant les protocoles, ce qui les rend difficilement comparables. Des investigations complémentaires sont nécessaires afin d’établir un modèle de TCC généralisable et consensuel.

Hallucinations, a residual symptom of pharmaco-resistant schizophrenia, represent a serious handicap. They cause psychic suffering, anxiety and depression. Based on the vulnerability-stress model, cognitive behavioral therapies (CBT) offer adaptable alternatives to the psychotic experience. This literature review presents a comparative analysis of several studies on the effects of CBT when used to treat auditory hallucinations in schizophrenia. It is therefore possible to better understand the methodologies, objectives and benefits as well as the limitations of this type of therapy when applied in group or individual settings.

Keywords “cognitive therapy”, “behavioural therapy”, “schizophrenia”, “hallucinations”, “voices” were entered into the US National Library of medicine database. The first sample, which included 45 articles, was restricted to comparative studies. Due to the small number of comparative studies specifically focusing on hallucinations, studies without a control group were included. The articles were divided into two categories: individual and group therapies. The target population, inclusion criteria, evaluation scales, type of technique used, length of treatment and follow-up, and observed results were compared for each therapy. The targets for the CBT intervention and methods used were summarized in two charts: one for individual therapy and one for group therapy.

In the category of individual therapies, Favrod et al. concluded that the CBT technique they used significantly decreased the stress generated by auditory hallucinations. Trower et al. identified that CBT decreases obedience to the voices and lessens their intensity. They formed the hypothesis that the intensity of the voices is a growing risk factor of obedience. Jenner et al. showed that for patients receiving CBT therapy, the negative content of voices, distress and burden of the hallucinations were reduced. England demonstrated that with adapted antipsychotic treatment and good therapeutic alliance during CBT, auditory hallucinations decreased. Finally, Thomas et al. highlighted the fact that the main prognostic factor of a bad response to CBT was the pre-existence of negative symptoms. In the group therapy category, Wykes et al., in 1999, identified that CBT reduces hallucinatory phenomena and anxiety, and increases insight and self-esteem. In 2005, Wykes et al. showed that group therapy for hallucinations improves social skills and that the severity of hallucinations is only diminished if therapy is administered by a very experienced therapist. Penn et al. suggested a group CBT protocol, which allowed participants to obtain a significant decrease in their global symptomatology, but, contrary to expectations, this CBT did not modify the intensity of the voices or anxiety. McLeod et al. found a positive effect of group CBT on the intensity and frequency of auditory hallucinations and attributed these good results to the quality of interaction amongst participants. Mortan et al., in 2011, compared their group therapy to a control group. They found beneficial effects of CBT on the frequency of hallucinations, psychic suffering and concerns linked to auditory hallucinations.

All of the studies presented show a beneficial effect of cognitive behavioral therapy, both individual and group, on schizophrenic patients suffering from auditory hallucinations. When the CBT protocol is elaborated to target other characteristics (insight, self-esteem, delusion) through hallucinations, the objective is often reached. Individual CBT seems adapted to patients with few negative symptoms and with social skills unsuitable for interaction in a group. Group CBT appears to be particularly accessible for structures, such as day centers. CBT has the advantage of reinforcing social skills and facilitating access to this therapeutic alternative for schizophrenic patients. The methodology used in this literature review has some pitfalls. The list of studies is not exhaustive. Bibliographic research was only carried out using a single database. The methods of patient recruitment and CBT techniques used were very heterogeneous for the studies retained. There was often bias in evaluation. There were numerous measurement parameters and sometimes differences between protocols. However, at the present time, there is no meta-analysis on the consequences of CBT of hallucinations in schizophrenic patients, with the exception of an article by Propst in 2010. This author reviewed nine articles and made several conclusions in line with our work. Our article makes comparisons between individual and group therapies, which, up to now, were little studied in literature.

Although it is established that CBT has beneficial effects in the treatment of auditory hallucinations in schizophrenic patients, opinions differ on the type of benefit. This literature review enabled the following question to be asked: what objective should be fixed with CBT to treat auditory hallucinations? Further research on the subject will no doubt establish consensual treatment protocols.