The January BABCP Article of the Month is from Behavioural and Cogntive Psychotherapy (BCP) and is entitled “Echoes of shame: a comparison of the characteristics and psychological sequelae of recalled shame experiences across the voice hearing continuum” by Rachel Brand, Rosalie Altman, Carla Nardelli, Maxine Raffoul, Marcela Matos and Catherine Bortolon

Over the last few years, we, among many other researchers, have been involved in the developing field of clinical and research work on trauma-related voice-hearing (hearing voices without the corresponding external stimuli, also known as auditory verbal hallucinations). Research has systematically found that past traumatic experiences are related to the emergence, severity, and content of voice-hearing experiences. Psychological theories posit that PTSD-like trauma-related memories may form the basis of voice-hearing experiences for some people.

Surprisingly, other negative life experiences that are not considered ‘big T’ traumas have received much less attention. Clinical experience has led us to believe that shaming life events may represent a particular vulnerability factor for voice-hearing. Clinically, we frequently see people who hear voices and describe strong experiences of being shamed (e.g., being humiliated, criticized, dismissed) that are reflected in the content of their voices (which can also seek to humiliate, criticize, and dismiss). Indeed, many people we work with clinically describe how shaming events might have triggered their voices or, instead, how their voices might remind them of these past experiences and their feelings of being inferior, worthless and unlovable.

In this article, we explore the potential role of experiences of shame in voice-hearing by comparing three groups (those with distressing voices, those with voices, but no distress, and those with no voices) on the types of shame memories they report and the psychological sequelae of these shaming life events (i.e., intrusiveness, avoidance and arousal associated with memories of these events, and feelings of shame and self criticism)

Individuals who reported distressing voice-hearing experiences described higher levels of alert as a result of thinking about their shameful experiences and more intrusive thoughts and memories related to these events when compared to the other two groups. Likewise, they also reported higher levels of self-criticism and heightened perception of being negatively evaluated by others. Conversely, we were surprised that participants, regardless of the presence of voice-hearing experience and related distress, reported that their shameful experiences were similar in terms of the type of shame experience recalled (physical/sexual abuse vs other), who was the reported shamer (e.g., parents, sibling, etc.) and the duration of the recalled shame experience.

While this research is only one step toward understanding the role of shaming life experiences in voice hearing, it suggests that the psychological sequelae of the event, rather them the event itself, may be more relevant when considering what leads to distressing voice-hearing experiences. That is to say that although it is important to work collectively to reduce and prevent traumatic and shameful experiences, supporting people to process and manage the psychological sequalae of these events is crucial. We hope our study will inspire other researchers to further explore the role of shame within voice-hearing experiences. We also hope this paper will prompt clinicians who work with people who hear voices to ask about their past traumatic and shameful experiences. More importantly, clinicians should help clients to process and make sense of these memories from a place of self-compassion.

Author Bio: Catherine Bortolon is an Associate Professor in Psychologist at the Université Grenoble Alpes, France and a member junior of the Institut Universitaire de France. Her expertise and interests are in understanding the role of emotions (including shame) and emotion regulation in psychotic experiences. She is also interested in developing interventions targeting emotional problems (including traumatic related ones) and psychotic symptoms.

Rachel Brand is a lecturer in clinical psychology at the University of the Sunshine Coast, Queensland, Australia. Her clinical and research work focuses on improving psychological interventions for people experiencing psychosis through understanding and ameliorating psychological factors that contribute to these experiences. She is particularly interested in the role of traumatic life events in psychotic symptoms.

From Craig Steel, Associate Editor of BCP: Why I chose this article 

This article reminds us of the importance of assessing and formulating the ‘whole person’ when working with symptoms associated with a psychotic disorder. The relationship between the content of voices and the person who hears them is still poorly understood. However, this article encourages us to assess beyond the possible direct links between voice content and past experience, and to consider the emotional connection as well. Adopting this approach may enable clinicians to focus on a person’s underlying emotional issues and to move away from focusing on the voices alone.