The aim of the current study was to examine how belief in the validity of hallucinations relates to the association between hallucination frequency and associated distress. In a sample of inpatients with psychotic symptoms, results demonstrated that hallucination believability predicted later distress after controlling for symptom frequency. In addition, results were consistent with the hypothesis that hallucination believability mediated the frequency- distress link. Recent randomized controlled trials have supported the efficacy of cognitive behavior therapy for schizophrenia and related psychotic disorders. Further evidence suggests that cognitive behavioral approaches that incorporate mindfulness and acceptance-based strategies may be effective in reducing the believability of positive symptoms. Future trials incorporating longitudinal designs and more detailed assessments of these variables are needed.