Researchers: Elisa Gatiss, Robert Dudley, Bryony McGregor, and Mark Freeston. Doctorate of Clinical Psychology, University of Newcastle Upon Tyne. UK.
Hallucinations and voice hearing have been traditionally associated with severe psychiatric illness. However, recent research has provided some evidence that auditory hallucinations are a normal psychological phenomenon commonly experienced in both ‘normal’ and clinical populations (eg Romme & Escher, 1996; Slade & Bentall, 1988). This has resulted in a shift in attitude towards voices and voice hearers; the mere presence of a voice per se is not considered to be the problem, rather it is the individual appraisal of, or meaning attributed to the voice that is important. Furthermore, studies have indicated that the experience of hearing voices can be positive in both those with psychosis (eg Chadwick & Birchwood, 1994; Johns et al., 2002) and evangelical Christians (Davies et al., 2001).
Recent advances in cognitive behaviour therapy for psychosis have led to the development of models to enhance psychological understanding and treatment of distressing auditory hallucinations (Morrison, 2001). However, there is an absence of research into people with psychosis who are not overtly distressed by their voices. The work that has been undertaken by Max Birchwood and colleagues found that voices perceived to be benevolent tend to be engaged, while those seen as malevolent are resisted. A comprehensive description and greater understanding of the psychological mechanisms underpinning the experience of positive voices we feel could lead to the development of a ‘normal’ model of auditory hallucinations. Such understanding could enable us to work more effectively with people with negative voices by highlighting potential therapeutic techniques, normalising the experience of hearing voices and fostering hope.
Owing to this interest in the experience of voices in the absence of distress we set out to discover what are the distinctive features of positive experiences of auditory hallucinations in people with psychosis who experience both positive and negative voices. In essence, we wanted to know what makes one voice seem positively and another seem negative.
We interviewed 14 people who had been using psychiatric services and who experienced voices on a regular and frequent basis. In particular, these people could identify either; a ‘good’ and a ‘bad’ voice, or could experience the same voice as either positive or negative at different times. Each person was interviewed using a semi structured interview on two occasions. On one occasion they were asked about the negative voice, and the other occasion they were asked about the positive voice (the order of the interview varied and was determined by the person).
The content or frequency was not the primary difference between the voice experiences. A positive voice experience could say unpleasant things, and a negative voice could say apparently nice comments. Rather positive voices were seen to play a greater role in providing companionship, comfort and support. Positive voices were seen to be more helpful than harmful whereas negative voices were the opposite way and seen as more harmful than helpful. Negative voices were seen to be less controllable. In both negative and positive voices it was difficult to stop the voice from talking, but was easier to have a conversation with a positive voice experience. As with previous research positive voices were engaged more than resisted, and negative voices were resisted more than engaged.
We are extending this work to see how people who experience voices but who have not experienced distress (and have not been in psychiatric services) regard their positive and negative voice experiences. We feel that we could learn from their experiences, their ways of coping and help better understand how to help people who do experience distress when hearing voices.
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