Question 1

What are ways to help patients manage/cope with hallucinations without medications?

Mark Hayward · Accepted Answer

We have developed, evaluated and implemented a number of psychological interventions within the Sussex Voices Clinic https://www.sussexpartnership.nhs.uk/therapies-sussex-voices-clinic:

* Coping Strategy Enhancement – seeking to adapt existing coping strategies to maximise benefits - offered individually over four sessions 
* Guided Self-help CBT – targeting some of the mechanisms that can maintain voice-related distress - offered individually over 8 sessions 
* Relating Therapy – facilitating the development of assertive responding to voices and other people - offered individually over 16 sessions

Question 2

Can cognitive-behavioral therapy help with this and if so, how?

Mark Hayward · Accepted Answer

CBT can help by supporting people to view and respond to their voices in ways that are slower and more considered. This contrasts with the emotionally charged reactions that, whilst natural and understandable in the face of a threatening other, are likely to maintain voice-related distress. Within the Sussex Voices Clinic, we encourage patients to:

STOP – reacting to your voices – as this may not be helping.
 
QUESTION – your experiences and assumptions:
  
Do voices have all the power and control?
Can voices make bad things happen?
Do voices speak the truth?
Do you have some control?
 
CHOOSE – how you want to respond after you’ve taken a step back and re-evaluated some of your assumptions about yourself and your voice-hearing experiences.

Question 3

I should read your book first. However, would it be helpful to listen to recorded messages similar to the auditory hallucination reduce the level of distress due to "exposure" or "flooding"? What else would work better? Thank you.

Mark Hayward · Accepted Answer

Turning towards and engaging with voices is an important aspect of the relationally-based therapies that are currently being developed, e.g., Relating Therapy https://bit.ly/3LZAXcu and AVATAR Therapy https://bit.ly/33OL2I6 . Whilst exposure to the voices may be one of the active ingredients of change within these therapies, this process needs to occur within a safe and supported therapeutic environment where different responses to voices can be taught and experienced.

Question 4

How can I help a young person whose 'positive voice' disappeared at the start of treatment? She has only 'neutral' and 'negative' left.

Mark Hayward · Accepted Answer

Whether we are working with adults or young people, the same principles apply – we can’t change the voices, so we focus on changing the way we view and respond to them. This may involve the adaptation of coping strategies, re-evaluating the accuracy of our beliefs about ourselves and voices, or learning to respond more assertively. Most of our patients report some positive changes after therapy, but they say that voices rarely change.

Question 5

Are auditory verbal hallucinations always part of psychosis or can they occur with other psychiatric disorders? Is there evidence that mentally well people can experience them too?

Mark Hayward · Accepted Answer

The pioneering work of Marius Romme and Sandra Eshcher in the 1980s helped us to appreciate that voice hearing experiences are not exclusively a psychiatric phenomenon. Many people who hear voices can cope with or even benefit from these experiences and do not need support from mental health services https://bit.ly/3ImkUDy . When people do seek support from mental health services, they can be given a variety of diagnoses, e.g., Borderline Personality Disorder https://bit.ly/3JYpGYl

Question 6

Why is CBT not offered more widely to people experiencing psychosis?

Mark Hayward · Accepted Answer

One reason for the lack of access to CBT for psychosis (CBTp) is limited resources. CBTp is typically delivered by highly trained therapists (usually Clinical Psychologists) who are few in number. Our response to this problem has been to explore the contribution that can be made by Assistant Psychologists. Our recent trial offered some promising findings when Guided Selp-help CBT was delivered by Assistant Psychologists https://bit.ly/3tatazV . A full trial is due to commence in April 2022.

Question 7

Are mindfulness based approaches safe for people hearing voices?

Mark Hayward · Accepted Answer

Yes! We have extensive experience in developing, evaluating and implementing mindfulness-based therapy groups for patients distressed by voices. The mindfulness practices are adapted for this patient group, e.g., short practices with continuous guidance. Our trial suggested that mindfulness-based interventions were safe and beneficial https://bit.ly/3JV8rH8

Treating Auditory Hallucinations

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