A Randomized Controlled Trial of a Web-Based Cognitive-Behavioral Therapy Intervention for Persons with Schizophrenia with Distressing Auditory Hallucinations: “Coping with Voices”



NARSAD Young Investigator Grant

Anita F. and Robert C. Mitchell Memorial Investigator Award

Boston University Dudley Allen Sargent Research Award


1/01/10 – 12/31/13

Contact: Jennifer Gottlieb


Between 25-40% of people with schizophrenia experience persistent psychotic symptoms, despite adherence to antipsychotic medications. These symptoms contribute to distress, interfere with social and role functioning, and predict relapses and rehospitalizations. Thus, reducing psychotic symptoms, and the distress and impairments related to them, is an important treatment priority. Over the past 15 years, 34 controlled studies have evaluated the efficacy of Cognitive Behavioral Therapy for Psychosis (CBTp), and have shown significant reductions in hallucinations and delusions, as well as improved functioning. CBTp is a recommended treatment according to both PORT and NICE guidelines for schizophrenia, leading to calls for increased dissemination of this evidence-based practice. However, very few people have access to CBTp in the U.S. Obstacles to accessing CBTp include both the small pool of clinicians trained in the practice and limited patient access to mental health clinics, particularly in rural areas. There is clearly a need for innovative approaches to increasing access to CBTp.

To address the problem of low access to CBTp, a 10-lesson internet-based self-guided program for coping with auditory hallucinations was developed, “Coping with Voices.” Coping with Voices was developed by Dr. Jen Gottlieb, a clinical psychologist with expertise in CBTp, with software development by Brian Chiko, founder of the website www.schizophrenia.com, and currently of Cognitive Health Innovations, Inc. This is a 10-“session” (lesson) interactive computerized game-based web-intervention, composed of multiple exercises and games to exemplify CBT principles (e.g., thoughts influence feelings and behaviors), as well as behavioral (use of humming and earphones to quiet auditory hallucinations) and cognitive (e.g., challenging beliefs that voices have power over the person) coping techniques.

Following a successful pilot study of the intervention, a more rigorous randomized controlled trial (RCT) is taking place with clients of the Cambridge Health Alliance Central Street Clinic in Cambridge, MA. In this study, 45 individuals with a schizophrenia spectrum disorder who have moderate (or higher) levels of auditory hallucinations will be randomized to receive either the 10-session Coping with Voices program, or to their Usual Care. Participants will work on the program on a weekly basis at the Cambridge Health Alliance, and will be proctored by study staff. All participants will be assessed before the intervention begins, then at post-treatment, and then again 3 months following the post-treatment interview to evaluate severity of auditory hallucinations and other psychiatric symptoms. The results of this study will help to further refine the user-friendliness and effectiveness of this CBT intervention.

BU Center for Psychiatric Rehabilitation Staff Role
Jennifer Gottlieb, Ph.D. Principal Investigator
Vasudha Gidugu, M.A. Recruitment/Evaluator
Mihoko Maru, M.A. Participant Proctor
Other Participating Colleagues/Staff Role
Brian Chiko, B.S. Software Development
Ruth Barron, M.D. Cambridge Health Alliance Site PI
Miriam Tepper, M.D. Cambridge Health Alliance Site Co-Investigator
Jennifer Greenwold, M.D. Cambridge Health Alliance Site Co-Investigator
Matt Davis, M.D. Cambridge Health Alliance Site Co-Investigator
Elston Meckle, LICSW Cambridge Health Alliance Site Co-Investigator


Web-based cognitive-behavioral therapy for auditory hallucinations in persons with psychosis: a pilot study.
Gottlieb JD, Romeo KH, Penn DL, Mueser KT, Chiko BP. (2013).
Schizophrenia Research, 145(1-3), 82–87.


Inquiries related to the project should be addressed to:

Jennifer Gottlieb

Boston University, Center for Psychiatric Rehabilitation
940 Commonwealth Avenue West, 2nd Floor
Boston, MA 02215