Exploring the phenomenology of voices : a cognitive approach

‘Voices’ or auditory hallucinations are a common phenomenon in clinical settings. In recent years, primarily in the United Kingdom, cognitive behavioural researchers have begun to turn their attention to the psychoses in general and voices and delusions in particular. Researchers have sought to develop theoretical models of voices to inform understanding and clinical intervention. Chadwick and Birchwood’s (1994) model, particularly, emphasises the role of delusional beliefs about voices. The present volume explores the role that beliefs about voices may have in understanding people’s reactions to voices and in alleviating the difficulties often associated with this experience. An initial review of the literature focused on the current evidence for a role of delusional beliefs about voices in mediating the emotional and behavioural response to voices. Evidence, from theoretical and outcome studies, was considered in assessing the validity of a cognitive model and areas for future research identified. A particular form of behavioural response to voices i.e. ‘safety behaviours’ was then investigated. Types of safety behaviours used by voice hearers were compared to those reported in persecutory delusions by an inter-rater reliability study of the Safety Behaviour Questionnaire (Freeman, Garety and Kuipers, 2001). These categories were applicable to voice hearers. The role of safety behaviours in maintaining delusional beliefs about voices, threat appraisal and distress was examined. Voice hearers with schizophrenia were compared on structured interview and questionnaire measures. Safety behaviours were implicated in the maintenance of delusional beliefs and distress. Clinical implications and areas for future research were discussed. Finally, ethical, methodological and clinical issues were considered along with personal reflections on the research process in the reflective research review.