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The Omnipotence of Voices: A Cognitive Approach to Auditory Hallucinations

  • Paul Chadwick (a1) and Max Birchwood (a2)

Extract

We offer provisional support for a new cognitive approach to understanding and treating drug-resistant auditory hallucinations in people with a diagnosis of schizophrenia. Study 1 emphasises the relevance of the cognitive model by detailing the behavioural, cognitive and affective responses to persistent voices in 26 patients, demonstrating that highly disparate relationships with voices - fear, reassurance, engagement and resistance - reflect vital differences in beliefs about the voices. All patients viewed their voices as omnipotent and omniscient. However, beliefs about the voice's identity and meaning led to voices being construed as either ‘benevolent’ or ‘malevolent’. Patients provided cogent reasons (evidence) for these beliefs which were not always linked to voice content; indeed in 31 % of cases beliefs were incongruous with content, as would be anticipated by a cognitive model. Without fail, voices believed to be malevolent provoked fear and were resisted and those perceived as benevolent were courted. However, in the case of imperative voices, the primary influence on whether commands were obeyed was the severity of the command. Study 2 illustrates how these core beliefs about voices may become a new target for treatment. We describe the application of an adapted version of cognitive therapy (CT) to the treatment of four patients' drug-resistant voices. Where patients were on medication, this was held constant while beliefs about the voices' omnipotence, identity, and purpose were systematically disputed and tested. Large and stable reductions in conviction in these beliefs were reported, and these were associated with reduced distress, increased adaptive behaviour, and, unexpectedly, a fall in voice activity. These changes were corroborated by the responsible psychiatrists. Collectively, the cases attest to the promise of CT as a treatment for auditory hallucinations.

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American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.
Bauer, S. (1970) The function of hallucinations: an inquiry into the relationship of hallucinatory experience to creative thought. In Origin and Mechanisms of Hallucinations (ed. Keup, W.). New York: Plenum.
Beck, A. T., Rush, A. J., Shaw, B. F., et al (1979) Cognitive Therapy of Depression. New York: Guilford.
Benjamin, L. S. (1989) Is chronicity a function of the relationship between the person and the auditory hallucination? Schizophrenia Bulletin, 15, 291310.10.1093/schbul/15.2.291
Birchwood, M. J. (1986) Control of auditory hallucinations using earplugs through occlusion of monaural auditory input. British Journal of Psychiatry, 149, 104107.10.1192/bjp.149.1.104
Birchwood, M. J. & Tarrier, N. (1992) Innovations in the Psychological Management of Schizophrenia. Chichester: Wiley.
Brett-Jones, J., Garety, P. A. & Hemsley, D. R. (1987) Measuring delusional experiences: a method and its application. British Journal of Clinical Psychology, 26, 257265.10.1111/j.2044-8260.1987.tb01359.x
Brier, A. & Strauss, J. S. (1983) Self control in psychiatric disorders. Archives of General Psychiatry, 40, 11411145.10.1001/archpsyc.1983.01790090103016
Bruner, J. (1957) Going beyond the information given. In Contemporary Approaches to Cognition (eds H. E. Gruver, K. R. Hammond & R. Jessor). Cambridge, MA: Harvard University Press.
Chadwick, P. D. J. & Lowe, C. F. (1990) Measurement and modification of delusional beliefs. Journal of Consulting and Clinical Psychology, 58, 225232.10.1037/0022-006X.58.2.225
Chadwick, P. D. J. & Birchwood, M. J. (1994) Cognitive Therapy for Delusions and Hallucinations. Chichester: Wiley. (In press.)
Clements, K. & Turpin, G. (1992) Vulnerability models and schizophrenia: the assessment and prediction of relapse. In Innovations in the Psychological Management of Schizophrenia (eds M. Birchwood & N. Tarrier). Chichester: Wiley.
Falloon, I. R. H. & Talbot, R. E. (1981) Persistent auditory hallucinations: coping mechanisms and implications for management. Psychological Medicine, 11, 329339.10.1017/S0033291700052144
Fowler, D. & Morley, S. (1989) The cognitive behavioural treatment of hallucinations and delusions: a preliminary study. Behavioural Psychotherapy, 17, 267282.10.1017/S0141347300016700
Gilbert, P. (1984) Depression: From Psychology to Brain State. London: Lawrence Erlbaum Associates.
Hibbert, G. A. (1984) Ideational components of anxiety: their origins and content. British Journal of Psychiatry, 144, 618624.10.1192/bjp.144.6.618
Kingdon, D. G. & Turkington, D. (1991) The use of cognitive behaviour therapy with a normalising rationale in schizophrenia. Journal of Nervous Disease, 179, 207211.10.1097/00005053-199104000-00005
Maher, B. A. (1988) Anomalous experience and delusional thinking: the logic of explanations. In Delusional Beliefs (eds T. E. Oltmanns & B. A. Maher). New York: Wiley.
Markova, I. S. & Berrios, G. E. (1992) The meaning of insight in clinical psychology. British Journal of Psychiatry, 160, 850860.10.1192/bjp.160.6.850
Miligram, S. (1974) Obedience to Authority. New York: Harper & Row.
Parkinson, B. & Manstead, A. S. R. (1992) Appraisal as a cause of emotion. In Emotion (ed. Clarke, M.). London: Sage.
Romme, M. A. J. & Escher, A D. M. A. C. (1989) Hearing voices. Schizophrenia Bulletin, 209217.
Slade, P. & Bentall, R. P. (1988) Sensory Deception: A Scientific Analysis of Auditory Hallucinations. Chichester: Wiley.
Strauss, J. S. (1989) Subjective experience of schizophrenia. Schizophrenia Bulletin, 15, 179188.10.1093/schbul/15.2.179
Tarrier, N. (1987) An investigation of residual positive symptoms in discharged schizophrenic patients. British Journal of Clinical Psychology, 26, 141143.10.1111/j.2044-8260.1987.tb00740.x
Tennen, H. & Affleck, G. (1990) Blaming others for threatening events. Psychological Bulletin, 108, 209232.10.1037/0033-2909.108.2.209
Vygotsky, L. S. (1962) Thought and Language. Cambridge, MA: Harvard University Press.10.1037/11193-000
Yalom, I. (1970) The Theory and Practice of Group Psychotherapy. New York: Basic Books.
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  • EISSN: 1472-1465
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The Omnipotence of Voices: A Cognitive Approach to Auditory Hallucinations

  • Paul Chadwick (a1) and Max Birchwood (a2)
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