1
|
Brewin CR. Identity - A critical but neglected construct in cognitive-behaviour therapy. J Behav Ther Exp Psychiatry 2023; 78:101808. [PMID: 36435550 DOI: 10.1016/j.jbtep.2022.101808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 10/26/2022] [Accepted: 11/12/2022] [Indexed: 11/24/2022]
Abstract
In cognitive-behaviour therapy attention paid to the self and identity has primarily involved self-representations (the Me-Self) rather than how the self is experienced (the I-Self). Within the I-Self experiences vary on a continuum from pre-reflective consciousness (raw experienced perceptions and states of being) to self-awareness (permitting reflection on and evaluation of subjective experience). There is considerable evidence that the I-Self is affected in many if not all disorders, and I review illustrative studies of OCD, eating disorders, body dysmorphic disorder, PTSD, and personality disorder. These indicate that patients often experience themselves as being defective in various ways, or as having an unstable or contradictory I-Self. Recognition of this neglected aspect of patients' experience has major implications for assessment and treatment. For example, acknowledgment that their sense of self may fluctuate dramatically from moment to moment, may be fragmented, or may consist of a sense of emptiness, may help to build a more empathic therapeutic relationship. If frightening or distressing pre-reflective experiences are the cause of avoidance or other maladaptive coping strategies, conscious attention paid to them in therapy may help to better integrate the I-Self and Me-Self, restoring a sense of predictability and control.
Collapse
|
2
|
Brewin CR, Phillips K, Morton J, Mason AJC, Saunders R, Longden E. Multiplicity in the experience of voice-hearing: A phenomenological inquiry. J Psychiatr Res 2022; 156:564-569. [PMID: 36368246 DOI: 10.1016/j.jpsychires.2022.10.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/17/2022] [Accepted: 10/28/2022] [Indexed: 11/07/2022]
Abstract
Although it is recognized that voice-hearers often report a large number and variety of voices there have been few investigations of this multiplicity. Understanding the phenomenology of voice-hearing can provide a firm foundation for theorizing about its causes. In this international online survey of voice-hearers, details were elicited of the content of up to five utterances associated with up to five voices from each respondent. The contents were independently rated and associated with characteristics of each voice such as its perceived age, whether it had changed over time, and whether it was of a familiar person. We investigated predictors (e.g., diagnoses, voice gender, age first heard) of utterance negativity, length, and whether voices referred to themselves. The average number of voices reported was approximately four. The majority were perceived as male and had negative content. Child-aged voices were significantly less negative than all other voices except those perceived as being elderly. Multi-level analyses indicated that there was significant variability at the level of different utterances within voices but variability was more prominent at the level of different voices within an individual. The data were inconsistent with general cognitive models for hearing voices such as the misattribution of inner speech and were more congruent with a dissociation model of voice-hearing. Our findings support approaches based on subtype or dimensional methods of classifying voices, and additionally indicate that research and clinical assessment may benefit from more systematic assessment of multiplicity.
Collapse
Affiliation(s)
| | | | | | | | | | - Eleanor Longden
- Greater Manchester Mental Health NHS Foundation Trust, University of Manchester, UK
| |
Collapse
|
3
|
Fielding-Smith SF, Greenwood KE, Wichers M, Peters E, Hayward M. Associations between responses to voices, distress and appraisals during daily life: an ecological validation of the cognitive behavioural model. Psychol Med 2022; 52:538-547. [PMID: 32646525 DOI: 10.1017/s0033291720002238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cognitive models propose that behavioural responses to voices maintain distress by preventing disconfirmation of negative beliefs about voices. We used Experience Sampling Methodology (ESM) to examine the hypothesized maintenance role of behavioural responses during daily life. METHOD Thirty-one outpatients with frequent voices completed a smartphone-based ESM questionnaire 10 times a day over 9 days, assessing voice-related distress; resistance and compliance responses to voices; voice characteristics (intensity and negative content); appraisals of voice dominance, uncontrollability and intrusiveness. RESULTS In line with predictions, behavioural responses were associated with voice appraisals (dominance and uncontrollability), but not voice characteristics. Greater resistance and compliance were reported in moments of increased voice distress, but these associations did not persist after controlling for concurrent voice appraisals and characteristics. Voice distress was predicted by appraisals, and, unexpectedly, also by voice characteristics. As predicted, compliance and resistance were related to increases in distress at subsequent timepoints, whilst antecedent voice appraisals and characteristics had no such effect. Compliance, but not resistance, additionally predicted subsequent increases in voice uncontrollability. In both cases, the reverse models showed no association, indicating directional effects of responses on subsequent distress, and of compliance on uncontrollability appraisals. CONCLUSIONS These results provide support for the cognitive model by suggesting that momentary behavioural and emotional responses to voices are associated with concurrent negative voice appraisals. Findings suggest that behavioural responses may be driven by voice appraisals, rather than directly by distress, and may in turn maintain voice appraisals and associated distress during the course of daily life.
Collapse
Affiliation(s)
| | - Kathryn E Greenwood
- School of Psychology, University of Sussex, Brighton, UK
- Research & Development Department, Sussex Partnership NHS Foundation Trust, Hove, UK
| | - Marieke Wichers
- University of Groningen, University Medical Centre of Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Centre of Groningen, Groningen, the Netherlands
| | - Emmanuelle Peters
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
| | - Mark Hayward
- School of Psychology, University of Sussex, Brighton, UK
- Research & Development Department, Sussex Partnership NHS Foundation Trust, Hove, UK
| |
Collapse
|
4
|
Zanello A, Dugré JR. Preliminary Evidence for Heterogeneity of Beliefs About Auditory Verbal Hallucinations Intent. J Nerv Ment Dis 2021; 209:872-878. [PMID: 34846355 DOI: 10.1097/nmd.0000000000001391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Perceptions of patient's auditory verbal hallucinations (AVHs), commonly termed voices, have important impacts on their everyday lives. Despite research emphasizing the consequences of malevolent voices, preliminary results suggest that beliefs about voices may not be mutually exclusive. As such, we aimed to characterize the heterogeneity of beliefs about AVHs and describe their clinical correlates. We recruited 78 patients referred to a Voices group therapy for refractory and distressing voices. Based on the Revised Beliefs About Voices Questionnaire, clustering analysis yielded four subgroups of patients with distinct pattern of beliefs about AVHs. These subgroups differed significantly in terms of affective disturbances, engagement, and resistance to their voices. Furthermore, no significant changes in beliefs about voices were observed after 6 weeks. Results of the current study suggest that the heterogeneity regarding the beliefs about AVHs should be targeted in treatment to reduce their associated negative outcomes.
Collapse
Affiliation(s)
- Adriano Zanello
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | | |
Collapse
|
5
|
Wang X, Qi W, Chan S, Shi Z. Development and psychometric evaluation of a Chinese version of auditory hallucination risk assessment scale in patients with a diagnosis of schizophrenia. J Clin Nurs 2020; 29:3414-3424. [DOI: 10.1111/jocn.15379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/25/2020] [Accepted: 06/05/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Xingxing Wang
- Department of Nursing Shanghai Jiao Tong University School of Medicine Affiliated Shanghai Mental Health Center Shanghai China
| | - Wenwen Qi
- Department of Psychogeriatrics Shanghai Jiao Tong University School of Medicine Affiliated Shanghai Mental Health Center Shanghai China
| | - Sally Chan
- Singapore campus University of Newcastle CallaghanNSW Australia
| | - Zhongying Shi
- Department of Nursing Shanghai Jiao Tong University School of Medicine Affiliated Shanghai Mental Health Center Shanghai China
| |
Collapse
|
6
|
Couto MLDO, Kantorski LP. Ouvidores de vozes: uma revisão sobre o sentido e a relação com as vozes. PSICOLOGIA USP 2018. [DOI: 10.1590/0103-656420180077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Este estudo se trata de uma revisão sistematizada da literatura e teve como objetivo revisar os achados sobre o tema ouvidores de vozes, enfatizando a relação deles com suas vozes. A investigação foi realizada em duas bases de dados, PubMed e Lilacs, sem limite temporal e com os seguintes termos em inglês: “voice hearing” OR “auditory verbal hallucination”. A busca resultou no total de 2.464 títulos de artigos que foram examinados quanto à adequação ao objetivo. Identificaram-se 126 artigos para análise de texto completo, dos quais 35 preencheram critérios para inclusão. Evidenciou-se que o sentido que o ouvidor atribui às vozes está atrelado a sua história de vida, fazendo ele as considerar ameaçadoras, intrusivas, controladoras, ou gentis, amigáveis e positivas. Portanto, o sentido atribuído às vozes se mostrou determinante na relação que o ouvidor estabelecerá com elas mesmas, bem como a forma como ele se relaciona socialmente.
Collapse
|
7
|
Larøi F, Thomas N, Aleman A, Fernyhough C, Wilkinson S, Deamer F, McCarthy-Jones S. The ice in voices: Understanding negative content in auditory-verbal hallucinations. Clin Psychol Rev 2018; 67:1-10. [PMID: 30553563 DOI: 10.1016/j.cpr.2018.11.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/23/2018] [Accepted: 11/10/2018] [Indexed: 12/25/2022]
Abstract
Negative voice-content is the best sole predictor of whether the hearer of an auditory-verbal hallucination will experience distress/impairment necessitating contact with mental health services. Yet, what causes negative voice-content and how interventions may reduce it remains poorly understood. This paper offers definitions of negative voice content and considers what may cause negative voice-content. We propose a framework in which adverse life-events may underpin much negative voice-content, a relation which may be mediated by mechanisms including hypervigilance, reduced social rank, shame and self-blame, dissociation, and altered emotional processing. At a neurological level, we note how the involvement of the amygdala and right Broca's area could drive negative voice-content. We observe that negative interactions between hearers and their voices may further drive negative voice-content. Finally, we consider the role of culture in shaping negative voice-content. This framework is intended to deepen and extend cognitive models of voice-hearing and spur further development of psychological interventions for those distressed by such voices. We note that much of the relevant research in this area remains to be performed or replicated. We conclude that more attention needs to be paid to methods for reducing negative voice-content, and urge further research in this important area.
Collapse
Affiliation(s)
- Frank Larøi
- Department of Biological and Medical Psychology, University of Bergen, Jones Lies vei 91, Bergen 5009, Norway; Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium; NORMENT - Norwegian Centre of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway.
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia; Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, Australia
| | - André Aleman
- Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Sam Wilkinson
- Department of Sociology, Philosophy and Anthropology, University of Exeter, Exeter, UK
| | | | | |
Collapse
|
8
|
Forsén Mantilla E, Clinton D, Birgegård A. Insidious: The relationship patients have with their eating disorders and its impact on symptoms, duration of illness, and self-image. Psychol Psychother 2018; 91:302-316. [PMID: 29080248 PMCID: PMC6175392 DOI: 10.1111/papt.12161] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/18/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVES In published clinical and autobiographical accounts of eating disorders, patients often describe their disorder in personified ways, that is, relating to the disorder as if it were an entity, and treatment often involves techniques of externalization. By encouraging patients to think about their eating disorder as a relationship, this study aimed to examine how young female patients experience their eating disorder as acting towards them, how they react in response, and whether these interactions are associated with symptoms, illness duration, and self-image. DESIGN Structural Analysis of Social Behavior (SASB) was used to operationalize how patients experience the actions of their eating disorder and their own reactions to the disorder. METHOD The relationship between patients (N = 150) and their eating disorders was examined with respect to symptoms, duration of illness, and self-image. Patients were also compared on their tendency to react with affiliation in relation to their disorder. RESULTS Patients' responses on the SASB indicated that they tended to conceptualize their eating disorders as blaming and controlling, and they themselves as sulking and submitting in response. Greater experience of the eating disorder as being controlling was associated with higher levels of symptomatology. Patients reacting with more negative affiliation towards their disorder were less symptomatic. CONCLUSIONS When encouraging patients to think about their eating disorder as a relationship, comprehensible relationship patterns between patients and their eating disorders emerged. The idea that this alleged relationship may resemble a real-life relationship could have theoretical implications, and its exploration may be of interest in treatment. PRACTITIONER POINTS Patients were able to conceptualize their eating disorder as a significant other to whom they relate when encouraged to do so. Patients tended to experience their disorder as controlling and domineering. Exploring the hypothetical patient-eating disorder relationship may prove helpful in understanding dysfunctional relational patterns. Helping patients to rebel against their eating disorder could potentially aid in symptom reduction.
Collapse
Affiliation(s)
- Emma Forsén Mantilla
- Centre for Psychiatry ResearchDepartment of Clinical NeuroscienceKarolinska InstituteStockholmSweden,Stockholm Health Care ServicesStockholm County CouncilStockholmSweden
| | - David Clinton
- Centre for Psychiatry ResearchDepartment of Clinical NeuroscienceKarolinska InstituteStockholmSweden,Stockholm Health Care ServicesStockholm County CouncilStockholmSweden,Institute for Eating DisordersOsloNorway
| | - Andreas Birgegård
- Centre for Psychiatry ResearchDepartment of Clinical NeuroscienceKarolinska InstituteStockholmSweden,Stockholm Health Care ServicesStockholm County CouncilStockholmSweden
| |
Collapse
|
9
|
Strauss C, Hugdahl K, Waters F, Hayward M, Bless JJ, Falkenberg LE, Kråkvik B, Asbjørnsen AE, Johnsen E, Sinkeviciute I, Kroken RA, Løberg EM, Thomas N. The Beliefs about Voices Questionnaire - Revised: A factor structure from 450 participants. Psychiatry Res 2018; 259:95-103. [PMID: 29035759 PMCID: PMC5764292 DOI: 10.1016/j.psychres.2017.09.089] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 08/31/2017] [Accepted: 09/30/2017] [Indexed: 12/30/2022]
Abstract
Hallucinated voices are common across psychiatric and non-clinical groups. The predominant cognitive theory about the impact of voices posits that beliefs about voice power ('Omnipotence') and voice intent ('Malevolence'/'Benevolence') play a key role in determining emotional and behavioral reactions. The revised Beliefs about Voices Questionnaire (BAVQ-R) was designed to assess these constructs, together with two styles of responding (Engagement and Resistance). The BAVQ-R is widely used in clinical and research settings, yet it has not received validation of its constructs and factor structure. This study examined the factor structure of the BAVQ-R by combining datasets from five study centers, comprising 450 participants (belief constructs) and 269 participants (response styles), and using confirmatory and exploratory factor analysis. Findings failed to support a three factor belief model, instead showing a two-factor structure ('Persecutory beliefs' combining Omnipotence and Malevolence constructs, and a Benevolent construct). Emotional and behavioral items did not separate. Overall, results showed that (i) a two-factor model of beliefs (Persecutory and Benevolent beliefs) provides a better fit to the data than a three-factor model, and (ii) emotional and behavioral modes of responding items should not be separated. Theoretical implications of this finding are discussed in relation to the research and therapy.
Collapse
Affiliation(s)
- Clara Strauss
- School of Psychology, University of Sussex, Brighton BN1 9QH, UK; Sussex Partnership NHS Foundation Trust, Hove, UK.
| | - Kenneth Hugdahl
- Department of Biological and Medical Psychology, University of Bergen, Norway,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway,NORMENT Center of Excellence, University of Oslo, Norway
| | - Flavie Waters
- Clinical Research Centre, North Metro Health Service, Graylands Hospital, Perth, Australia,School of Psychiatry and Clinical Neurosciences, University of Western Australia, Australia
| | - Mark Hayward
- School of Psychology, University of Sussex, Brighton BN1 9QH, UK,Sussex Partnership NHS Foundation Trust, Hove, UK
| | - Josef J. Bless
- Department of Biological and Medical Psychology, University of Bergen, Norway,NORMENT Center of Excellence, University of Oslo, Norway
| | - Liv E. Falkenberg
- Department of Biological and Medical Psychology, University of Bergen, Norway,NORMENT Center of Excellence, University of Oslo, Norway
| | - Bodil Kråkvik
- Nidaros District Psychiatric Center, Department of Research and Development, St. Olavs University Hospital, Trondheim, Norway
| | | | - Erik Johnsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway,NORMENT Center of Excellence, University of Oslo, Norway,Department of Clinical Medicine (K1), University of Bergen, Norway
| | - Igne Sinkeviciute
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway,NORMENT Center of Excellence, University of Oslo, Norway,Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Rune A. Kroken
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway,NORMENT Center of Excellence, University of Oslo, Norway,Department of Clinical Medicine (K1), University of Bergen, Norway
| | - Else-Marie Løberg
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway,NORMENT Center of Excellence, University of Oslo, Norway,Department of Clinical Medicine (K1), University of Bergen, Norway,Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway,Department of Clinical Psychology, University of Bergen, Norway
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia,Voices Clinic, Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical School, Melbourne, Australia
| |
Collapse
|
10
|
Hayward M, Jones AM, Bogen-Johnston L, Thomas N, Strauss C. Relating Therapy for distressing auditory hallucinations: A pilot randomized controlled trial. Schizophr Res 2017; 183:137-142. [PMID: 27916286 DOI: 10.1016/j.schres.2016.11.019] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 11/05/2016] [Accepted: 11/13/2016] [Indexed: 11/24/2022]
Abstract
Auditory hallucinations (AH) are a common and distressing experience and patients report distress reduction to be a priority. Relating Therapy adopts a symptom-specific and mechanism focused approach to the reduction of AH distress. We conducted this single-blind, pragmatic, parallel groups, superiority pilot RCT within a single mental health centre in the UK. Patients (18+years) with persistent and distressing AH, irrespective of diagnosis were randomly allocated to receive either Relating Therapy and Treatment-as-usual (RT) or Treatment as-usual alone (TAU). Assessment of outcome was completed pre-randomisation (T0), 16weeks post-randomisation (T1) and 36weeks post-randomisation (T2). The primary outcome was the 5-item Distress scale of the Psychotic Symptoms Rating Scale - Auditory Hallucinations (PSYRATS-AHRS) at T1. We randomly assigned 29 patients to receive RT (n=14) or TAU (n=15). Twenty-five patients (86%) provided complete datasets. Compared with TAU, RT led to reductions in AH distress in the large effect size range across T1 and T2. Our findings suggest that Relating Therapy might be effective for reducing AH distress. A larger, suitably powered phase 3 study is needed to provide a precise estimate of the effects of Relating Therapy for AH distress.
Collapse
Affiliation(s)
- Mark Hayward
- School of Psychology, University of Sussex, Brighton BN1 9RH, United Kingdom.
| | | | | | - Neil Thomas
- Swinburne University of Technology, Australia.
| | - Clara Strauss
- School of Psychology, University of Sussex, Brighton BN1 9RH, United Kingdom.
| |
Collapse
|
11
|
Hayward M, Slater L, Berry K, Perona-Garcelán S. Establishing the "Fit" between the Patient and the Therapy: The Role of Patient Gender in Selecting Psychological Therapy for Distressing Voices. Front Psychol 2016; 7:424. [PMID: 27065907 PMCID: PMC4814658 DOI: 10.3389/fpsyg.2016.00424] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 03/10/2016] [Indexed: 11/19/2022] Open
Abstract
The experience of hearing distressing voices has recently attracted much attention in the literature on psychological therapies. A new “wave” of therapies is considering voice hearing experiences within a relational framework. However, such therapies may have limited impact if they do not precisely target key psychological variables within the voice hearing experience and/or ensure there is a “fit” between the profile of the hearer and the therapy (the so-called “What works for whom” debate). Gender is one aspect of both the voice and the hearer (and the interaction between the two) that may be influential when selecting an appropriate therapy, and is an issue that has thus far received little attention within the literature. The existing literature suggests that some differences in voice hearing experience are evident between the genders. Furthermore, studies exploring interpersonal relating in men and women more generally suggest differences within intimate relationships in terms of distancing and emotionality. The current study utilized data from four published studies to explore the extent to which these gender differences in social relating may extend to relating within the voice hearing experience. The findings suggest a role for gender as a variable that can be considered when identifying an appropriate psychological therapy for a given hearer.
Collapse
Affiliation(s)
- Mark Hayward
- School of Psychology, University of Sussex Brighton, UK
| | - Luke Slater
- Sussex Education Centre, Sussex Partnership NHS Foundation Trust Hove, UK
| | - Katherine Berry
- School of Psychological Sciences, University of Manchester Manchester, UK
| | - Salvador Perona-Garcelán
- Personality, Evaluation and Psychological Treatment Department, University of SevilleSeville, Spain; Virgen del Rocío Outpatient Mental Hospital, University Hospital Virgen del RocíoSeville, Spain
| |
Collapse
|
12
|
Chaix J, Ma E, Nguyen A, Ortiz Collado MA, Rexhaj S, Favrod J. Safety-seeking behaviours and verbal auditory hallucinations in schizophrenia. Psychiatry Res 2014; 220:158-62. [PMID: 25219615 DOI: 10.1016/j.psychres.2014.08.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 08/21/2014] [Accepted: 08/24/2014] [Indexed: 11/19/2022]
Abstract
Verbal auditory hallucinations can have a strong impact on the social and professional functioning of individuals diagnosed with schizophrenia. The safety-seeking behaviours used to reduce the threat associated with voices play a significant role in explaining the functional consequences of auditory hallucinations. Nevertheless, these safety-seeking behaviours have been little studied. Twenty-eight patients with schizophrenia and verbal auditory hallucinations were recruited for this study. Hallucinations were evaluated using the Psychotic Symptom Rating Scale and the Belief About Voice Questionnaire and safety behaviours using a modified version of the Safety Behaviour Questionnaire. Our results show that the vast majority of patients relies on safety behaviours to reduce the threat associated with voices. This reliance on safety behaviours is mostly explained by beliefs about origin of voices the omnipotence attributed to hallucinations and the behavioural and emotional reactions to the voices. Safety-seeking behaviours play an important role in maintaining dysfunctional beliefs with respect to voices. They should be better targeted within the cognitive and behavioural therapies for auditory hallucinations.
Collapse
Affiliation(s)
- Joséphine Chaix
- School of Nursing Sciences, University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland
| | - Edgar Ma
- School of Nursing Sciences, University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland
| | - Alexandra Nguyen
- School of Nursing Sciences, University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland
| | - Maria Assumpta Ortiz Collado
- School of Nursing Sciences, University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland
| | - Shyhrete Rexhaj
- School of Nursing Sciences, University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland; Community Psychiatry Service, Department of Psychiatry, University Hospital Centre of Lausanne, Switzerland
| | - Jérôme Favrod
- School of Nursing Sciences, University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland; Community Psychiatry Service, Department of Psychiatry, University Hospital Centre of Lausanne, Switzerland.
| |
Collapse
|
13
|
McCarthy-Jones S, Thomas N, Strauss C, Dodgson G, Jones N, Woods A, Brewin CR, Hayward M, Stephane M, Barton J, Kingdon D, Sommer IE. Better than mermaids and stray dogs? Subtyping auditory verbal hallucinations and its implications for research and practice. Schizophr Bull 2014; 40 Suppl 4:S275-84. [PMID: 24936087 PMCID: PMC4141311 DOI: 10.1093/schbul/sbu018] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 01/24/2014] [Accepted: 01/27/2014] [Indexed: 12/17/2022]
Abstract
The phenomenological diversity of auditory verbal hallucinations (AVH) is not currently accounted for by any model based around a single mechanism. This has led to the proposal that there may be distinct AVH subtypes, which each possess unique (as well as shared) underpinning mechanisms. This could have important implications both for research design and clinical interventions because different subtypes may be responsive to different types of treatment. This article explores how AVH subtypes may be identified at the levels of phenomenology, cognition, neurology, etiology, treatment response, diagnosis, and voice hearer's own interpretations. Five subtypes are proposed; hypervigilance, autobiographical memory (subdivided into dissociative and nondissociative), inner speech (subdivided into obsessional, own thought, and novel), epileptic and deafferentation. We suggest other facets of AVH, including negative content and form (eg, commands), may be best treated as dimensional constructs that vary across subtypes. After considering the limitations and challenges of AVH subtyping, we highlight future research directions, including the need for a subtype assessment tool.
Collapse
Affiliation(s)
- Simon McCarthy-Jones
- Department of Cognitive Science, ARC Centre of Excellence in Cognition and Its Disorders, Macquarie University, Sydney, Australia; Department of Psychology, Durham University, Durham, UK;
| | - Neil Thomas
- Brain and Psychological Sciences Centre, Swinburne University, Melbourne, Australia; Monash Alfred Psychiatry Research Centre, Melbourne, Australia
| | - Clara Strauss
- School of Psychology, University of Sussex, Sussex, UK; Sussex Partnership NHS Foundation Trust, Sussex, UK
| | - Guy Dodgson
- Early Intervention in Psychosis, Northumberland, Tyne and Wear NHS FT, Newcastle, UK
| | - Nev Jones
- Department of Psychology, DePaul University, Chicago, IL
| | - Angela Woods
- Centre for Medical Humanities, Durham University, Durham, UK
| | - Chris R Brewin
- Division of Psychology & Language Sciences, University College London, London, UK
| | - Mark Hayward
- School of Psychology, University of Sussex, Sussex, UK; Sussex Partnership NHS Foundation Trust, Sussex, UK
| | - Massoud Stephane
- Department of Psychiatry, Oregon Health and Science University, Portland, OR
| | - Jack Barton
- Department of Psychology, Durham University, Durham, UK
| | - David Kingdon
- Department of Psychiatry, University of Southampton, Southampton, UK
| | - Iris E Sommer
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
14
|
Hayward M, Berry K, McCarthy-Jones S, Strauss C, Thomas N. Beyond the omnipotence of voices: further developing a relational approach to auditory hallucinations. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2013. [DOI: 10.1080/17522439.2013.839735] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
15
|
Abstract
Background:In people who experience auditory verbal hallucinations, beliefs the person holds about their voices appear to be clinically important as mediators of associated distress and disability. Whilst such beliefs are thought to be influenced by broader schematic representations the person holds about themselves and other people, there has been little empirical examination of this, in particular in relation to beliefs about voice intent and the personal meaning of the voice experience.Method:Thirty-four voice hearers with a diagnosis of schizophrenia or schizoaffective disorder completed the Psychotic Symptom Rating Scales and measures of beliefs about voices (Revised Beliefs About Voices Questionnaire, Interpretation of Voices Inventory) and schemas (Brief Core Schema Scales).Results:Beliefs about voices were correlated with both negative voice content and schemas. After controlling for negative voice content, schemas were estimated to predict between 9% and 35% of variance in the six beliefs about voices that were measured. Negative-self schemas were the strongest predictors, and positive-self and negative-other schemas also showed potential relationships with beliefs about voices.Conclusions:Schemas, particularly those regarding the self, are potentially important in the formation of a range of clinically-relevant beliefs about voices.
Collapse
|
16
|
Hayward M, Berry K, Ashton A. Applying interpersonal theories to the understanding of and therapy for auditory hallucinations: a review of the literature and directions for further research. Clin Psychol Rev 2011; 31:1313-23. [PMID: 21996292 DOI: 10.1016/j.cpr.2011.09.001] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 08/30/2011] [Accepted: 09/02/2011] [Indexed: 11/30/2022]
Abstract
Cognitive models of auditory hallucinations are being elaborated in an attempt to more fully understand the variables that determine the distress often experienced by hearers. There is a growing body of literature that aims to explore the relevance of the concept of 'relating' to the experience of auditory hallucinations. This review explored the relevance of interpersonal perspectives to both understandings of and therapy for auditory hallucinations. Eighteen papers were included, published between 1989 and 2010. Studies have utilised and are reviewed within three different theoretical perspectives: Benjamin's Structural Analysis of Social Behaviour; Gilbert's Social Rank Theory; and Birtchnell's Relating Theory. Qualitative studies have explored the nature of the person's relationships with their auditory hallucinations, and are also reviewed. Collectively, the studies suggest that the experience of auditory hallucinations can be understood within interpersonal frameworks, and the relationships that hearers develop with their hallucinations share many properties with interpersonal relationships within the social world. Two themes were prominent across studies: an understanding of the power of the hearer, relative to both auditory hallucinations and social relationships; and the broader influence of social factors that extends beyond power to encompass broader patterns of relating. Findings are considered with regard to clinical implications and future research.
Collapse
Affiliation(s)
- Mark Hayward
- University of Sussex & Sussex Partnership NHS Foundation Trust, Nevill Avenue, Hove BN3 7HZ, UK.
| | | | | |
Collapse
|
17
|
Paulik G. The role of social schema in the experience of auditory hallucinations: a systematic review and a proposal for the inclusion of social schema in a cognitive behavioural model of voice hearing. Clin Psychol Psychother 2011; 19:459-72. [PMID: 21774037 DOI: 10.1002/cpp.768] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
UNLABELLED The interpersonal nature of the voice-hearing experience has been highlighted in recent studies investigating whether social processes (or 'schemas') that guide interpersonal interactions also govern the relationship between voice hearer and voice. A systematic literature review of relevant studies was undertaken, including those that investigated how social processes interact with appraisals of voices, as well as affective and behavioural responding to voices. The review included 13 studies published between 2000 and 2010. Two well-replicated findings emerged from the review. First, voice hearers who perceive themselves to be of low social rank (inferior) relative to others also feel inferior in relation to their voice and behave accordingly. Second, responding to voices from a position of closeness/dependency is associated with least distress. The review advocates for an extension of the Chadwick and Birchwood cognitive behavioural model of voices to include the mediating role of social schemata in explaining the affective and behavioural responses to voices. Only two interventions have yet targeted social schema variables utilizing different therapeutic approaches, both with some success. These clinical studies, as well as clinical implications drawn from the reviewed literature, will be discussed. KEY PRACTITIONER MESSAGE Social processes governing relationships in the real world are also at play in the relationship between voice hearer and voice. Social schemas also shape beliefs about-and responses to-voices and thus are important to target in therapy. Voice hearers may be able to develop a more equal, and thus less distressing, relationship with their voice by improving their perceived social rank relative to others. This may be achieved through assertiveness training, social skills training and/or self-esteem work. Cognitive behavioural therapy techniques can be instrumental in helping an individual to consider the beliefs they hold about their voices and the way in which they respond and relate to them. Addressing how past traumatic experiences have influenced the voice hearer's relationships with others and their voices in therapy is recommended.
Collapse
Affiliation(s)
- Georgie Paulik
- School of Psychiatry, University of New South Wales, Australia.
| |
Collapse
|
18
|
Ratcliff K, Farhall J, Shawyer F. Auditory hallucinations: a review of assessment tools. Clin Psychol Psychother 2010; 18:524-34. [DOI: 10.1002/cpp.729] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|