Hearing voices is a distressing and trans-diagnostic experience. Cognitive behavioural therapy (CBT) is an effective psychological treatment for distressing voices, but is offered to only a minority of patients. Limited resources are a barrier to accessing CBT. Evaluations of brief forms of CBT for voices have offered encouraging findings, but the ability of briefly-trained therapists to deliver these brief therapies has yet to be explored. We evaluated the outcomes of a brief form of CBT (Coping Strategy Enhancement, CSE) for voices when delivered by highly-trained and briefly-trained therapists. This was a service evaluation comparing pre–post outcomes in patients who had completed brief CSE over four sessions, within NHS Mental Health Services, delivered by highly-trained and briefly-trained therapists. The primary outcome was the negative impact scale of the Hamilton Program for Schizophrenia Voices Questionnaire. Data were available from 92 patients who completed a course of brief CSE – nearly half of whom received therapy from a briefly-trained therapist. Modest benefits across the sample were consistent with previous evaluations and did not seem to be influenced by the training of the therapist. This service evaluation offers further evidence that brief CSE can begin a therapeutic conversation about distressing voices within routine clinical practice. The usefulness of this initial conversation does not seem to be reliant upon the extent of therapist training, suggesting that briefly-trained therapists may play a role in increasing access to these conversations for patients distressed by hearing voices.

Background: A prominent area of advancement in the psychological treatment for people with persisting psychosis has been the application of mindfulness-based therapies. Recent literature has recommended the investigation of focused mindfulness interventions for voices (auditory hallucinations) as a specific experience. To date, only mindfulness programs in group format have been examined. Aims: This non-randomized pilot study aimed to assess the acceptability, feasibility and potential outcomes of an individual mindfulness program for persistent voices on the negative impact of voices on the subjective experience of mental health and wellbeing, depression and voice-related distress and disruption. Also, it aimed to identify potential psychological and neurocognitive mechanisms of change. Method: A new 4-week individual Mindfulness Program for Voices (iMPV) was developed, and piloted with a group of 14 participants with a schizophrenia-spectrum disorder and persisting voices. Participants completed clinical and neurocognitive measures pre- and post-intervention and at 2-month follow-up. Results: Results revealed low attrition rates, high formal practice engagement levels and positive participant feedback. Pre–post outcomes suggested small to moderate effects for a reduction in the negative impact of voices on experience, depression and disruption. Large effects for changes in mindful responding and attentional switching were also identified. Conclusions: Our findings suggest that this novel treatment protocol is appropriate, engaging and safe for persistent voice hearers. Findings for mindful responding and attentional switching suggest these to be potential mechanisms of change for further investigation. Further RCTs are warranted to ascertain the feasibility and efficacy for focused mindfulness interventions for voices of individual format.

Background: Whilst evidence is mounting that childhood sexual abuse (CSA) can be a cause of auditory verbal hallucinations (AVH), it is unclear what factors mediate this relation. Recent evidence suggests that post-traumatic symptomatology may mediate the CSA–AVH relation in clinical populations, although this hypothesis has not yet been tested in the general population. There is also reason to believe that obsessive ideation could mediate the CSA–AVH relation. Aims: To test for evidence to falsify the hypotheses that post-traumatic symptomatology, obsessions, compulsions, anxiety and depression mediate the relation between CSA and AVH in a general population sample. Method: Indirect effects of CSA on AVH via potential mediators were tested for, using a regression-based approach employing data from the 2007 Adult Psychiatric Morbidity Survey (n = 5788). Results: After controlling for demographics, IQ and child physical abuse, it was found that CSA, IQ, post-traumatic symptomatology and compulsions predicted lifetime experience of AVH. Mediation analyses found significant indirect effects of CSA on AVH via post-traumatic symptomatology [odds ratio (OR): 1.11; 95% confidence interval (CI):1.00–1.29] and compulsions (OR: 1.10, 95% CI: 1.01–1.28). Conclusions: These findings offer further support for the hypothesis that post-traumatic symptomatology is a mediator of the CSA–AVH relation. Although no evidence was found for obsessional thoughts as a mediating variable, a potential mediating role for compulsions is theoretically intriguing. This study's findings reiterate the need to ask about experiences of childhood adversity and post-traumatic symptomology in people with AVH, as well as the likely therapeutic importance of trauma-informed and trauma-based interventions for this population.

Background: Studies of both clinical and non-clinical voice hearers suggest that distress is rather inconsistently associated with the perceived relationship between voice and hearer. It is also not clear if their beliefs about voices are relevant. Aims: This study investigated the links between attachment anxiety/avoidance, interpersonal aspects of the voice relationship, and distress whilst considering the impact of beliefs about voices and paranoia. Method: Forty-four voice-hearing participants completed a number of self-report measures tapping attachment, interpersonal processes in the voice relationship, beliefs about voices, paranoia, distress and depression. Results: Attachment avoidance was related to voice intrusiveness, hearer distance and distress. Attachment anxiety was related to voice intrusiveness, hearer dependence and distress. A series of simple mediation analyses were conducted that suggest that the relationship between attachment and voice related distress may be mediated by interpersonal dynamics in the voice-hearer relationship, beliefs about voices and paranoia. Conclusions: Beliefs about voices, the hearer's relationship with their voices, and the distress voices sometimes engender appear to be meaningfully related to their attachment style. This may be important to consider in therapeutic work.

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.

Background: Despite an increasing volume of cross-sectional work on auditory verbal hallucinations (hearing voices), there remains a paucity of work on how the experience may change over time. Aims: The first aim of this study was to attempt replication of a previous finding that beliefs about voices are enduring and stable, irrespective of changes in the severity of voices, and do not change without a specific intervention. The second aim was to examine whether voice-hearers’ interrelations with their voices change over time, without a specific intervention. Method: A 12-month longitudinal examination of these aspects of voices was undertaken with hearers in routine clinical treatment (N = 18). Results: We found beliefs about voices’ omnipotence and malevolence were stable over a 12-month period, as were styles of interrelating between voice and hearer, despite trends towards reductions in voice-related distress and disruption. However, there was a trend for beliefs about the benevolence of voices to decrease over time. Conclusions: Styles of interrelating between voice and hearer appear relatively stable and enduring, as are beliefs about the voices’ malevolent intent and power. Although there was some evidence that beliefs about benevolence may reduce over time, the reasons for this were not clear. Our exploratory study was limited by only being powered to detect large effect sizes. Implications for clinical practice and future research are discussed.

Background: Previous research suggests that the distress experienced by clinical voice hearers is associated with the perceived relationship between voice and hearer, independent of beliefs about voices and depression. Aims: This study aimed to replicate these findings and generate further hypotheses by comparing the voice hearing experiences of clinical and non-clinical hearers. Method: A cross-sectional, quantitative design was employed and used between-subjects and correlational methods. Thirty-two clinical voice hearers and 18 non-clinical voice hearers were assessed using the PSYRATS, the Voice and You questionnaire, the Beliefs About Voices Questionnaire – Revised, and the Beck Depression Inventory-II. Results: For clinical voice hearers, distress was significantly associated with perceptions of the voice as dominating and intrusive, and hearers distancing themselves from the voice. However, these associations were not independent of beliefs about voices’ omnipotence or malevolence. Non-clinical voice hearers were significantly less distressed than clinical voice hearers and voices were perceived as less dominant, intrusive, malevolent and omnipotent. Non-clinical hearers were found to relate from a position of less distance to voices perceived as benevolent. Conclusions: Findings from previous research were only partially replicated. Clinically, the development of less maladaptive relationships between voice and voice hearer may reduce distress.