***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Comm and hallucinations are a distressing and high-risk group of symptoms that have long been recognised but little understood , with few effective treatments . In line with our recent research , we propose that the development of an effective cognitive therapy for comm and hallucinations ( CTCH ) would be enhanced by applying insights from social rank theory . AIMS We tested the efficacy of CTCH in reducing beliefs about the power of voices and thereby compliance , in a single-blind , r and omised controlled trial . METHOD A total of 38 patients with comm and hallucinations , with which they had recently complied with serious consequences , were allocated r and omly to CTCH or treatment as usual and followed up at 6 months and 12 months . RESULTS Large and significant reductions in compliance behaviour were obtained favouring the cognitive therapy group ( effect size 1.1 ) . Improvements were also observed in the CTCH but not the control group in degree of conviction in the power and superiority of the voices and the need to comply , and in levels of distress and depression . No change in voice topography ( frequency , loudness , content ) was observed . The differences were maintained at 12 months ' follow-up . CONCLUSIONS The results support the efficacy of cognitive therapy for CTCH Comm and hallucinations represent a special problem for the clinical management of psychosis . While compliance with both non-harmful and harmful comm and s can be problematic , sometimes in the extreme , active efforts to resist comm and s may also contribute to their malignancy . Previous research suggests Cognitive Behaviour Therapy ( CBT ) to be a useful treatment for reducing compliance with harmful comm and hallucinations . The purpose of this trial was to evaluate whether CBT augmented with acceptance-based strategies from Acceptance and Commitment Therapy could more broadly reduce the negative impact of comm and hallucinations .  Forty-three participants with problematic comm and hallucinations were r and omized to receive 15 sessions of the intervention " TORCH " ( Treatment of Resistant Comm and Hallucinations ) or the control , Befriending , then followed up for 6 months . A sub- sample of 17 participants was r and omized to a waitlist control before being allocated to TORCH or Befriending . Participants engaged equally well with both treatments . Despite TORCH participants subjectively reporting greater improvement in comm and hallucinations compared to Befriending participants , the study found no significant group differences in primary and secondary outcome measures based on blinded assessment data . Within-group analyses and comparisons between the combined treatments and waitlist suggested , however , that both treatments were beneficial with a differential pattern of outcomes observed across the two conditions OBJECTIVE The authors developed and evaluated the reliability and validity of the Brown Assessment of Beliefs Scale , a clinician-administered seven-item scale design ed to assess delusions across a wide range of psychiatric disorders . METHOD The authors developed the scale after review ing the literature on the assessment of delusions . Four raters administered the scale to 20 patients with obsessive-compulsive disorder ( OCD ) , 20 patients with body dysmorphic disorder , and 10 patients with mood disorder with psychotic features .  Audiotaped interviews of scale administration conducted by one rater were independently scored by the other raters to evaluate interrater reliability . The scale was administered to 27 patients twice to determine test-retest reliability . Other insight instruments as well as scales that assess symptom severity were administered to assess convergent and discriminant validity . Sensitivity to change was assessed in a multicenter treatment study of sertraline for OCD . RESULTS Interrater and test-retest reliability for the total score and individual item scores was excellent , with a high degree of internal consistency . One factor was obtained that accounted for 56 % of the variance . Scores on the Brown Assessment of Beliefs Scale were not correlated with symptom severity but were correlated with other measures of insight . The scale was sensitive to change in insight in OCD but was not identical to improvement in severity . CONCLUSIONS The Brown Assessment of Beliefs Scale is a reliable and valid instrument for assessing delusionality in a number of psychiatric disorders . This scale may help clarify whether delusional and nondelusional variants of disorders constitute the same disorder as well as whether delusionality affects treatment outcome and prognosis The present study examined the impact of a brief version of an acceptance-based treatment ( acceptance and commitment therapy ; ACT ) that teaches patients to accept unavoidable private events ; to identify and focus on actions directed toward valued goals ; and to defuse from odd cognition , just noticing thoughts rather than treating them as either true or false . Eighty inpatient participants with positive psychotic symptoms were r and omly assigned to treatment as usual ( TAU ) or to 4 sessions of ACT plus TAU . ACT participants showed significantly higher symptom reporting and lower symptom believability and a rate of rehospitalization half that of TAU participants over a 4-month follow-up period . The same basic pattern of results was seen with all participant subgroups except delusional participants who denied symptoms Background Persecutory delusions may be unfounded threat beliefs maintained by safety-seeking behaviours that prevent disconfirmatory evidence being successfully processed . Use of virtual reality could facilitate new learning . Aims To test the hypothesis that enabling patients to test the threat predictions of persecutory delusions in virtual reality social environments with the dropping of safety-seeking behaviours ( virtual reality cognitive therapy ) would lead to greater delusion reduction than exposure alone ( virtual reality exposure ) . Method Conviction in delusions and distress in a real-world situation were assessed in 30 patients with persecutory delusions . Patients were then r and omised to virtual reality cognitive therapy or virtual reality exposure , both with 30 min in grade d virtual reality social environments . Delusion conviction and real-world distress were then reassessed . Results In comparison with exposure , virtual reality cognitive therapy led to large reductions in delusional conviction ( reduction 22.0 % , P = 0.024 , Cohen 's d = 1.3 ) and real-world distress ( reduction 19.6 % , P = 0.020 , Cohen 's d = 0.8 ) . Conclusion Cognitive therapy using virtual reality could prove highly effective in treating delusions Auditory hallucinations ( AH ) are a common and distressing experience and patients report distress reduction to be a priority . Relating Therapy adopts a symptom-specific and mechanism focused approach to the reduction of AH distress . We conducted this single-blind , pragmatic , parallel groups , superiority pilot RCT within a single mental health centre in the UK . Patients ( 18+years ) with persistent and distressing AH , irrespective of diagnosis were r and omly allocated to receive either Relating Therapy and Treatment-as-usual ( RT ) or Treatment as-usual alone ( TAU ) . Assessment of outcome was completed pre-r and omisation ( T0 ) , 16weeks post-r and omisation ( T1 ) and 36weeks post-r and omisation ( T2 ) . The primary outcome was the 5-item Distress scale of the Psychotic Symptoms Rating Scale - Auditory Hallucinations ( PSYRATS-AHRS ) at T1 . We r and omly assigned 29 patients to receive RT ( n=14 ) or TAU ( n=15 ) . Twenty-five patients ( 86 % ) provided complete data sets . Compared with TAU , RT led to reductions in AH distress in the large effect size range across T1 and T2 . Our findings suggest that Relating Therapy might be effective for reducing AH distress . A larger , suitably powered phase 3 study is needed to provide a precise estimate of the effects of Relating Therapy for AH distress Group Person-Based Cognitive Therapy ( PBCT ) integrates cognitive therapy and mindfulness to target distinct sources of distress in psychosis . The present study presents data from the first r and omised controlled trial investigating group PBCT in people distressed by hearing voices . One-hundred and eight participants were r and omised to receive either group PBCT and Treatment As Usual ( TAU ) or TAU only . While there was no significant effect on the primary outcome , a measure of general psychological distress , results showed significant between-group post-intervention benefits in voice-related distress , perceived controllability of voices and recovery . Participants in the PBCT group reported significantly lower post-treatment levels of depression , with this effect maintained at six-month follow-up . Findings suggest PBCT delivered over 12 weeks effectively impacts key dimensions of the voice hearing experience , supports meaningful behaviour change , and has lasting effects on mood We have developed a novel therapy based on a computer program , which enables the patient to create an avatar of the entity , human or non-human , which they believe is persecuting them . The therapist encourages the patient to enter into a dialogue with their avatar , and is able to use the program to change the avatar so that it comes under the patient ’s control over the course of six 30-min sessions and alters from being abusive to becoming friendly and supportive . The therapy was evaluated in a r and omised controlled trial with a partial crossover design . One group went straight into the therapy arm : “ immediate therapy ” . The other continued with st and ard clinical care for 7 weeks then crossed over into Avatar therapy : “ delayed therapy ” . There was a significant reduction in the frequency and intensity of the voices and in their omnipotence and malevolence . Several individuals had a dramatic response , their voices ceasing completely after a few sessions of the therapy . The average effect size of the therapy was 0.8 . We discuss the possible psychological mechanisms for the success of Avatar therapy and the implication s for the origins of persecutory voices BACKGROUND One in four patients with schizophrenia responds poorly to antipsychotic medication , continuing to hear persecutory auditory hallucinations . Patients who are able to sustain a dialogue with their persecutor feel much more in control . AIMS To develop a computerised system that enables the patient to create an avatar of their persecutor . To encourage them to engage in a dialogue with the avatar , which the therapist is able to control so that the avatar progressively yields control to the patient . METHOD Avatar therapy was evaluated by a r and omised , single blind , partial crossover trial comparing the novel therapy with treatment as usual ( TAU ) . We used three main outcome measures : ( a ) the Psychotic Symptom Rating Scale ( PSYRATS ) , hallucinations section ; ( b ) the Omnipotence and Malevolence subscales of the Revised Beliefs About Voices Question naire ( BAVQ-R ) ; and ( c ) the Calgary Depression Scale ( CDS ) . RESULTS The control  group showed no change over time in their scores on the three assessment s , whereas the novel therapy group showed mean reductions in the total PSYRATS score ( auditory hallucinations ) of 8.75 ( P = 0.003 ) and in the BAVQ-R combined score of omnipotence and malevolence of the voices of 5.88 ( P = 0.004 ) . There was no significant reduction in the CDS total score for depression . For the crossover control group , comparison of the period of TAU with the period of avatar therapy confirmed the findings of the previous analysis . The effect size of the therapy was 0.8 . CONCLUSIONS Avatar therapy represents a promising treatment for medication-resistant auditory hallucinations . Replication with a larger sample is required before roll-out to clinical setting Summary Background Sleep disturbance occurs in most patients with delusions or hallucinations and should be treated as a clinical problem in its own right . However , cognitive behavioural therapy (CBT)—the best evidence -based treatment for insomnia — has not been tested in this patient population . We aim ed to pilot procedures for a r and omised trial testing CBT for sleep problems in patients with current psychotic experiences , and to provide a preliminary assessment of potential benefit . Methods We did this prospect i ve , assessor-blind , r and omised controlled pilot trial ( Better Sleep Trial [ BEST ] ) at two mental health centres in the UK . Patients ( aged 18–65 years ) with persistent distressing delusions or hallucinations in the context of insomnia and a schizophrenia spectrum diagnosis were r and omly assigned ( 1:1 ) , via a web-based r and omisation system with minimisation to balance for sex , insomnia severity , and psychotic experiences , to receive either eight sessions of CBT plus st and ard care ( medication and contact with the local clinical team ) or st and ard care alone . Research assessors were masked to group allocation . Assessment of outcome was done at weeks 0 , 12 ( post-treatment ) , and 24 ( follow-up ) . The primary efficacy outcomes were insomnia assessed by the Insomnia Severity Index ( ISI ) and delusions and hallucinations assessed by the Psychotic Symptoms Rating Scale ( PSYRATS ) at week 12 . We did analysis by intention to treat , with an aim to provide confidence interval estimation of treatment effects . This study is registered with IS RCT N , number 33695128 . Findings Between Dec 14 , 2012 , and May 22 , 2013 , and Nov 7 , 2013 , and Aug 26 , 2014 , we r and omly assigned 50 patients to receive CBT plus st and ard care ( n=24 ) or st and ard care alone ( n=26 ) . The last assessment s were completed on Feb 10 , 2015 . 48 ( 96 % ) patients provided follow-up data . 23 ( 96 % ) patients offered CBT took up the intervention . Compared with st and ard care , CBT led to reductions in insomnia in the large effect size range at week 12 ( adjusted mean difference 6·1 , 95 % CI 3·0–9·2 , effect size d=1·9 ) . By 
    Output:
    
Although targeted studies are still in their infancy , the results are promising with a tendency towards higher effects compared to the small-to-moderate range found for generic CBTp .