Assessing the delusion and alternative and empirical testing

Finally, the patient and therapist need to assess the delusion and alternative in the light of the available evidence and previous discussion. The therapist may spell out the advantages of the alternative interpretative framework, which can also be discussed by relating it to the patient's experiences.

It is an integral part of CBT that the belief or assumption under consideration be tested empirically. Such reality testing involves planning and performing an activity that validates or invalidates a belief, or part of a belief.

When working with delusions, we set up a clear alternative belief in opposition to the delusion, clarifying with the patient in advance precisely what has to happen for each to be supported and refuted. For example, ^l6 Alison believed that by repeating her voice's command (e.g. 'The price of milk will rise a billion times') it would actually happen by transmitting the thought to a member of the government who would act upon it. The empirical test involved repeating the voice and purchasing milk before and after doing so, predicting that within 2 weeks the price of milk would at least double. If it did not, the alternative (that the power to change events was very weak) would be strengthened.

Using appropriate procedures for working with auditory hallucinations Assessment

Assessing the personal meaning a voice has for a person is the defining feature of the cognitive approach to assessing auditory hallucinations. The delusional beliefs found to be most significant are those relating to a voice's identity, purpose, power, knowledge, and the consequences of compliance and resistance. The semistructured interview schedule developed by Chadwick and Birchwood(2 ,23) is recommended.

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