Boston University Sargent College of Health & Rehabilitation Sciences
Center for Psychiatric Rehabilitation

Boston University Sargent College of Health & Rehabilitation Sciences
Center for Psychiatric Rehabilitation

"Coping With Voices"

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


NARSAD Young Investigator Grant; Anita F. and Robert C. Mitchell Memorial Investigator Award; Boston University Dudley Allen Sargent Research Award


2010 - 2013


Kim Mueser, Ph.D., Co-Investigator


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 and tested. “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, 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) was conducted with clients of the Cambridge Health Alliance Central Street Clinic in Cambridge, MA. In this study, 37 individuals with a schizophrenia spectrum disorder who have moderate (or higher) levels of auditory hallucinations were randomized to receive either the 10-session Coping with Voices program, or to their Usual Care. Participants worked on the program on a weekly basis at the Cambridge Health Alliance, and were proctored by study staff. All participants were assessed before the intervention began, then at post-treatment, and then again 3 months following the post-treatment interview to evaluate severity of auditory hallucinations and other psychiatric symptoms. Results of this study helped to further refine the user-friendliness and effectiveness of this CBT intervention.



Principal Investigator: Jennifer Gottlieb, Ph.D.
Recruitment/Evaluator: Vasudha Gidugu, Ph.D..
Participant Proctor: Mihoko Maru, M.A.


This is a multi-site study. Please contact the Center investigator for additional information.



See the following publications:

Gottlieb JD, Gidugu V, Maru M, Tepper MC, Davis MJ, Greenwold J, Barron RA,
Chiko BP, Mueser KT. (2017). Randomized controlled trial of an internet cognitive behavioral skills-based program for auditory hallucinations in persons with psychosis. Psychiatric Rehabilitation Journal, 40, 283-292.



Inquiries related to the project should be addressed to:

Kim Mueser, Ph.D.
Boston University, Center for Psychiatric Rehabilitation
940 Commonwealth Avenue West, 2nd Floor
Boston, MA 02215