The ECHO Study: Compassion-focused Therapy for Young Voice Hearers and Their Caregivers (ECHO)

In this project, a 10-session treatment program was developed aimed at young people who experience voice hearing. The treatment has potential to easily be implemented in everyday clinical practice in Child and Adolescent Psychiatry, and eventually in Educational Psychological Counselling (PPR) and the newly established STIME services (low-threshold municipal treatment offers for children and young people).

As part of the treatment, the young person's caregivers are involved. This means a high degree of involvement from adults who know the young person well and are part of their daily life.

In addition to traditional Compassion-focuced therapy (CFT), the treatment is expanded with an intervention where an audio file is recorded with content corresponding to the adolescent's voice hearing. The parents are invited to listen to the audio file while participating in a therapy session. This will help improve the caregivers understanding of the young person's experiences and challenges.

Study Overview

• Status: Not yet recruiting
• Conditions: Hallucinations, Auditory
• Intervention / Treatment: Behavioral: ECHO Manualized CFT treatment for young voice heares

• Study Type: Interventional
• Enrollment (Estimated): 80
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Maja K Musaeus, Psychologist; Phone Number: +4591543221; Email: maja@musaeus.eu
• Study Contact Backup: Name: Vibeke F Bliksted, Professor; Email: vibeke.fuglsang.bliksted@rsyd.dk

Study Locations

• Denmark
  • Esbjerg, Denmark
    • Psychiatriatric Children and Youth Hospital
    • Contact: Maja K Musaeus, Psychologist; Phone Number: 91543221; Email: maja@musaeus.eu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• The participants should have been referred to a child and adolescent psychiatric hospital in Denmark .
• The participants have heard voices within the last 2 weeks.
• The participant can hear the content of the voices. The content takes the form of spoken works.
• A caregiver who can participate in 5 sessions

Exclusion Criteria:

• Participants has an estimated IQ under 70
• Participants who don't speak and understand Danish,
• Current drug misuse / abuse (during sessions)
• Brain injury or neurological disorder e.g. severe epilepsy
• Impaired vision or hearing to a degree that makes participation in therapy under normal conditions impossible.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: 10 sessions manualized CFT treatment for young voice heares; 60 voice hearing patients age 13-18 years old 20 patients with first-episode schizophrenia age 18-21	Behavioral: ECHO Manualized CFT treatment for young voice heares; A manualized 10 session, intervention inspired by compassion focused therapy. A primary caretaker paticipates in 5 sessions.; Other Names: Data is collected 3 months prior to CFT treatment, immediately before the start of treatment, immediately after treatment is completed, and at 1 month follow-up

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Interpretation and relationship with the voices	Psychotic symptoms are measured with: BAVQ-R (Beliefs about Voices Questionnaire - Revised) (Chadwick et al., 2000).( 35 items are rated (0-3) total minimum score 0, maximum score 105. Some scores indicate higher distress, while other indicate lower distress).	Data is collected 3 months prior to CFT treatment, immediately before the start of treatment, immediately after treatment is completed, and at 1 month follow-up.
Severity and phenomenological characteristics of voice hearing	PSYRATS AH (Psychotic Symptoms Rating Scale Auditory Hallucinations) (Haddock et al., 1999). (11 items are rated (0-4) total minimum score 0, maximum score 44. Higher score being more severe)	Data is collected 3 months prior to CFT treatment, immediately before the start of treatment, immediately after treatment is completed, and at 1 month follow-up.
Perceived ability to control or influence the voices	The Yale Control Over Perceptual Experiences (COPE) Scales measures voluntary control over voices such as being able to intentionally influence the timing, frequency, or intensity of voice hearing experiences (Mourgues et al., 2022). (36 items are rated (1-7) total minimum score 36, maximum score 252. Higher scores indicate stronger perceived control over voices)	Data is collected 3 months prior to CFT treatment, immediately before the start of treatment, immediately after treatment is completed, and at 1 month follow-up.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Social Cognition	Social cognition is tested with TASIT 2A DK (The Awareness of Social Inference Test) (McDonald et al., 2003). (60 items are rated, minimum total score 0, maximum score is 60. Lower score being more severe)	Social cognition is tested 3 months before treatment and right after
Subjective experience of feeling safe, accepted, and soothed in social relationships.	SSPS (Social safeness and pleasure scale) (Gilbert et al., 2009). (11 items are rated (1-5). Total minimum 11, total maximum 55. Lower score being more severe).	Data is collected 3 months prior to CFT treatment, immediately before the start of treatment, immediately after treatment is completed, and at 1 month follow-up
Compassion towards self.	SCS-SF (Self-Compassion Scale Short Form) (Raes et al., 2011; Neff et al., 2019) (12 items are rated (1-5) total minimum 12, total maximum 60. Lower score being more severe).	Data is collected 3 months prior to CFT treatment, immediately before the start of treatment, immediately after treatment is completed, and at 1 month follow-up
Subjective sense of interpersonal closeness and belonging	The Social Connectedness Scale Revised (Lee et al., 1995; Sabitelli et al., 2005). (8 items are rated (1-6). Total minimum score 8, total maximum score 48. Lower score being more severe).	Data is collected 3 months prior to CFT treatment, immediately before the start of treatment, immediately after treatment is completed, and at 1 month follow-up
Perceived availability and adequacy of social support	MSPSS (The Multidimensional Scale of Perceived Social Support) (Zimet et al. 1988).(12 items are rated (1-7) total minimum 12, total maximum 84. Lower score being more severe).	Data is collected 3 months prior to CFT treatment, immediately before the start of treatment, immediately after treatment is completed, and at 1 month follow-up

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Primary caregivers	Factual information about the young person: Education, cohabiting or divorced parents, the young person's residence, family history of mental illness, diagnosis and medication of the young person	Before treatment
Additional questions	Additionally, questions are asked about how well you feel your parents understand you (e.g., do they know what motivates you and what scares you?) (Likert scale 1-10). Questions about daily stress, sleep, violence and abuse, well-being and quality of life, interaction with family and friends (from the "How are you?" survey among youth in the Central Denmark Region). Quality of life is measured with WHO-5.	Data is collected 3 months prior to CFT treatment, immediately before the start of treatment, immediately after treatment is completed, and at 1 month follow-up

Collaborators and Investigators

• Sponsor: University of Southern Denmark
• Collaborators: Region Syddanmark
• Investigators: Study Chair: Charlie Heriot-Maitland, Dr., Balanced Minds

Publications and helpful links

General Publications

• Raes F, Pommier E, Neff KD, Van Gucht D. Construction and factorial validation of a short form of the Self-Compassion Scale. Clin Psychol Psychother. 2011 May-Jun;18(3):250-5. doi: 10.1002/cpp.702. Epub 2010 Jun 8.
• Zimet GD, Powell SS, Farley GK, Werkman S, Berkoff KA. Psychometric characteristics of the Multidimensional Scale of Perceived Social Support. J Pers Assess. 1990 Winter;55(3-4):610-7. doi: 10.1080/00223891.1990.9674095.
• Heriot-Maitland C. Position paper - CFT for psychosis. Psychol Psychother. 2024 Mar;97(1):59-73. doi: 10.1111/papt.12490. Epub 2023 Aug 14.
• Neff KD, Toth-Kiraly I, Yarnell LM, Arimitsu K, Castilho P, Ghorbani N, Guo HX, Hirsch JK, Hupfeld J, Hutz CS, Kotsou I, Lee WK, Montero-Marin J, Sirois FM, de Souza LK, Svendsen JL, Wilkinson RB, Mantzios M. Examining the factor structure of the Self-Compassion Scale in 20 diverse samples: Support for use of a total score and six subscale scores. Psychol Assess. 2019 Jan;31(1):27-45. doi: 10.1037/pas0000629. Epub 2018 Aug 20.
• Gilbert, P., Introducing compassion-focused therapy. Advances in psychiatric treatment, 2009. 15(3): p. 199-208.
• Mourgues C, Hammer A, Fisher V, Kafadar E, Quagan B, Bien C, Jaeger H, Thomas R, Sibarium E, Negreira AM, Sarisik E, Polisetty V, Nur Eken H, Imtiaz A, Niles H, Sheldon AD, Powers AR. Measuring Voluntary Control Over Hallucinations: The Yale Control Over Perceptual Experiences (COPE) Scales. Schizophr Bull. 2022 May 7;48(3):673-683. doi: 10.1093/schbul/sbab144.
• Woods, S. W., Parker, S., Kerr, M. J., Walsh, B. C., Wijtenburg, S. A., Prunier, N., Nunez, A. R., Buccilli, K., Mourgues-Codern, C., Brummitt, K., Kinney, K. S., Trankler, C., Szacilo, J., Colton, B.-L., Ali, M., Haidar, A., Billah, T., Huynh, K., Ahmed, U., Adery, L. L., Marcy, P. J., Allott, K., Amminger, P., Arango, C., Broome, M. R., Cadenhead, K. S., Chen, E. Y. H., Choi, J., Conus, P., Cornblatt, B. A., Glenthøj, L. B., Horton, L. E., Kambeitz, J., Kapur, T., Keshavan, M. S., Koutsouleris, N., Langbein, K., Lavoie, S., Diaz-Caneja, C. M., Mathalon, D. H., Mittal, V. A., Nordentoft, M., Pasternak, O., Pearlson, G. D., Gaspar, P. A., Shah, J. L., Smesny, S., Stone, W. S., Strauss, G. P., Wang, J., Corcoran, C. M., Perkins, D. O., Schiffman, J., Perez, J., Mamah, D., Ellman, L. M., Powers, A. R. III, Coleman, M. J., Anticevic, A., Fusar-Poli, P., Kane, J. M., Kahn, R. S., McGorry, P. D., Bearden, C . E., Shenton, M. E., Nelson, B., Calkins, M. E., Hendricks, L., Bouix, S., Addington, J., McGlashan, T. H., Yung, A. R., & The Accelerating Medicines Partnership Schizophrenia (2024). Development of the PSYCHS: Positive SYmptoms and Diagnostic Criteria for the CAARMS Harmonized with the SIPS. Early Intervention in Psychiatry, 18(4), 255-272. https://doi.org/10.1111/eip.13457
• Chandwick P, Lees S, Birchwood M. The revised Beliefs About Voices Questionnaire (BAVQ-R). Br J Psychiatry. 2000 Sep;177:229-32. doi: 10.1192/bjp.177.3.229.
• McDonald S, Flanagan S, Rollins J, Kinch J. TASIT: A new clinical tool for assessing social perception after traumatic brain injury. J Head Trauma Rehabil. 2003 May-Jun;18(3):219-38. doi: 10.1097/00001199-200305000-00001.

Study record dates

Study Major Dates

• Study Start (Estimated): June 1, 2026
• Primary Completion (Estimated): June 1, 2028
• Study Completion (Estimated): January 1, 2029

Study Registration Dates

• First Submitted: December 3, 2025
• First Submitted That Met QC Criteria: December 17, 2025
• First Posted (Actual): January 2, 2026

Study Record Updates

• Last Update Posted (Actual): February 24, 2026
• Last Update Submitted That Met QC Criteria: February 23, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: voice hearing
• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Neurobehavioral Manifestations; Perceptual Disorders; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Hallucinations
• Other Study ID Numbers: 1852876

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No