The Influence Of Social Schema On Cognitive Emotion Of Patients With Auditory Verbal Hallucinations And The Intervention Of Avatar Psychotherapy

Objective:1、Based on cognitive model of auditory verbal hallucinations,explore the relationship between social schemas,beliefs about voices and distress about voices and coping styles,and conduct path analysis.2.To develop a localized program of avatar therapy and explore the intervention effects of avatar therapy on auditory verbal hallucinations.Methods:1.Investigation study: 45 patients with auditory verbal hallucinations who met the nadir criteria in two hospitals in Shanxi were selected as the study subjects,and the general data of the patients were collected and assessed using the psychotic symptom rating scales-Auditory hallucinations,beliefs about voices questionnaire-revised,the voice power differential scale,voice rank scale,self-esteem scale,social power differential scale,social comparison scale,beck depression inventory.2.Intervention study: 20 patients with auditory verbal hallucinations who met the criteria for nadir were selected from two hospitals in Shanxi,and were treated with avatar therapy for a total of 7 sessions,once a week for 50-60 minutes each.Patients were assessed with relevant scales one week before and one week after the intervention,using assessment indicators consistent with the investigation study.Results:1.Investigation study:(1)distress was significantly positively correlated with malevolence(r =0.635,p<0.001)and omnipotence(r =0.522,p<0.001)and significantly negatively correlated with benevolence(r =-0.385,p=0.009).whereas the frequency was not significantly correlated with malevolence,benevolence or omnipotence.(2)Beliefs of voices malevolence(r=0.552,p<0.001)and omnipotence(r=0.541,p<0.001)were significantly associated with coping styles of resistance;beliefs of benevolence were significantly associated with coping styles of engagement(r=0.808,p<0.001);and beliefs that the voice was omnipotent were significantly associated with malevolence(r=0.712,p<0.001).(3)Patients who perceived themselves as having higher voice power felt significantly less social power in their relationships(t=5.509,p<0.001),were more vulnerable in social comparisons(t=-4.213,p<0.001),had greater distress(t=4.214,p<0.001),and had significantly higher levels of depression(t=2.232,p=0.031).Patients who perceived themselves as being more vulnerable in voice comparisons were also more vulnerable in social comparisons(t=8.237,p<0.001),had significantly lower perceived social strength or power(t=-6.131,p<0.001),higher levels of distress(t=-3.845,p<0.001)and higher levels of depression(t=-2.647,p=0.011).(4)The path analysis revealed a direct effect of distress,with an effect value of 0.33,and an indirect effect of social influence and self-esteem on the degree of distress,with effect values of 0.474 and-0.177,respectively.Voices influence can affect the degree of distress both arbitrarily and directly,and indirectly through malevolence,with a total effect of 0.718.2.Intervention study:(1)Compared to the pre-intervention period,psychotic symptom rating scalesAuditory hallucinations Total score(t=6.383,p<0.001),distress(t=6.229,p<0.001)and frequency of voices(t=5.453,p<0.001)were significantly lower after the avatar therapy.(2)Compared to pre-intervention,total beliefs about voices scores were significantly lower after avatar therapy(t=3.363,p=0.003)and beliefs in malevolence and omnipotence were significantly lower(t=3.939,p=0.001;t=3.270,p=0.005).(3)Compared to pre-intervention,after avatar therapy,there was a significant decrease in total the voice power differential scale scores(t=5.254,p<0.001),a significant increase in total voice rank scales cores(t=-3.340,p=0.003),a significant decrease in total social power differential scale scores(t=5.589,p<0.001),a significant increase in total social comparison scales scores(t=-3.201,p=0.005),a significant increase in total self-esteem scores(t=-2.404,p=0.027)and a significant decrease in depression levels(t=2.697,p=0.016).Conclusion:1.Investigation study:(1)The emotional behavioural responses of patients with verbal hallucinations are related to the patient’s beliefs about the hallucinations.Beliefs of voices is malevolence and omnipotence,patients also feel greater distress and adopt a resistant coping style.When the patient’s beliefs about the hearing are benevolent,the patient feels less distress and usually responds in a participatory manner.(2)The relationship of verbal hallucinations hearers to voices is related to their social schema.(3)voice power fully mediates between social schema and distress;malevolence play a part in voice power and voices distress mediating role.2.Intervention study: Avatar psychotherapy enhances the patient’s sense of power,increases the patient’s level of self-esteem,decrease the patient’s belief in omnipotence and malevolence,improves the patient’s relationship with the hallucinations,improves social schemas,relieves the distress caused by the hallucinations and improves the symptoms of the hallucinations.