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Related Experiment Video

Updated: Apr 4, 2026

Continuous Theta Burst Stimulation of the Posterior Medial Frontal Cortex to Experimentally Reduce Ideological Threat Responses

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Cognitive behaviour therapy to prevent harmful compliance with command hallucinations (COMMAND): a randomised

Max Birchwood¹, Maria Michail², Alan Meaden³

¹Division of Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK.

The Lancet. Psychiatry

|September 12, 2015

Summary

Cognitive therapy for command hallucinations significantly reduced harmful compliance in psychosis patients. This novel treatment challenges the perceived power of voices, offering a new approach to managing dangerous commands.

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Area of Science:

Psychiatry
Clinical Psychology
Neuroscience

Background:

Command hallucinations in psychosis pose significant risks.
No established treatments exist to mitigate harm from these commands.
A novel cognitive therapy was developed to address this unmet clinical need.

Purpose of the Study:

To evaluate the efficacy of a new cognitive therapy in reducing harmful compliance with command hallucinations.
To challenge the perceived power of voices to inflict harm.
To decrease patient motivation to comply with dangerous commands.

Main Methods:

A single-blind, randomized controlled trial (COMMAND) involving participants with persistent command hallucinations.
Participants were assigned to either cognitive therapy plus treatment as usual or treatment as usual alone.
The primary outcome measured was harmful compliance, with assessments at 9 and 18 months.

Main Results:

At 18 months, cognitive therapy significantly reduced harmful compliance (28% vs. 46%, OR 0.45, p=0.021).
While not significant at 9 months, a common treatment effect across follow-ups was observed (OR 0.57, p=0.042).
This indicates a clinically meaningful reduction in risk-taking behavior.

Conclusions:

This is the first trial demonstrating a clinically significant reduction in risk behaviors associated with command hallucinations.
Future research will investigate the mediating role of perceived voice power.
Further trials are needed to identify the most effective components of this cognitive therapy.