Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-26T13:43:35.197Z Has data issue: false hasContentIssue false
  • English
  • Français

Associations between responses to voices, distress and appraisals during daily life: an ecological validation of the cognitive behavioural model

Published online by Cambridge University Press:  10 July 2020

Sarah F. Fielding-Smith ,
Kathryn E. Greenwood ,
Marieke Wichers ,
Emmanuelle Peters  and
Mark Hayward Open the ORCID record for Mark Hayward [Opens in a new window]
Sarah F. Fielding-Smith
Affiliation:
School of Psychology, University of Sussex, Brighton, UK
Kathryn E. Greenwood
Affiliation:
School of Psychology, University of Sussex, Brighton, UK Research & Development Department, Sussex Partnership NHS Foundation Trust, Hove, UK
Marieke Wichers
Affiliation:
University of Groningen, University Medical Centre of Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Centre of Groningen, Groningen, the Netherlands
Emmanuelle Peters
Affiliation:
Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
Mark Hayward*
Affiliation:
School of Psychology, University of Sussex, Brighton, UK Research & Development Department, Sussex Partnership NHS Foundation Trust, Hove, UK
*
Author for correspondence: Mark Hayward, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Cognitive models propose that behavioural responses to voices maintain distress by preventing disconfirmation of negative beliefs about voices. We used Experience Sampling Methodology (ESM) to examine the hypothesized maintenance role of behavioural responses during daily life.

Method

Thirty-one outpatients with frequent voices completed a smartphone-based ESM questionnaire 10 times a day over 9 days, assessing voice-related distress; resistance and compliance responses to voices; voice characteristics (intensity and negative content); appraisals of voice dominance, uncontrollability and intrusiveness.

Results

In line with predictions, behavioural responses were associated with voice appraisals (dominance and uncontrollability), but not voice characteristics. Greater resistance and compliance were reported in moments of increased voice distress, but these associations did not persist after controlling for concurrent voice appraisals and characteristics. Voice distress was predicted by appraisals, and, unexpectedly, also by voice characteristics. As predicted, compliance and resistance were related to increases in distress at subsequent timepoints, whilst antecedent voice appraisals and characteristics had no such effect. Compliance, but not resistance, additionally predicted subsequent increases in voice uncontrollability. In both cases, the reverse models showed no association, indicating directional effects of responses on subsequent distress, and of compliance on uncontrollability appraisals.

Conclusions

These results provide support for the cognitive model by suggesting that momentary behavioural and emotional responses to voices are associated with concurrent negative voice appraisals. Findings suggest that behavioural responses may be driven by voice appraisals, rather than directly by distress, and may in turn maintain voice appraisals and associated distress during the course of daily life.

Keywords

Appraisalsauditory verbal hallucinationscognitive modelexperience samplingdistressresponsesvoice hearing
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 3 , February 2022 , pp. 538 - 547
Check for updates
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abramowitz, J. S., Tolin, D. F., & Street, G. P. (2001). Paradoxical effects of thought suppression: A meta-analysis of controlled studies. Clinical Psychology Review, 21(5), 683–703. http://doi.org/10.1016/S0272-7358(00)00057-X.CrossRefGoogle ScholarPubMed
Barrowcliff, A. L., & Haddock, G. (2006). The relationship between command hallucinations and factors of compliance: A critical review of the literature. Journal of Forensic Psychiatry & Psychology, 17(2), 266–298. http://doi.org/10.1080/14789940500485078.CrossRefGoogle Scholar
Bauer, D. J., Preacher, K. J., & Gil, K. M. (2006). Conceptualizing and testing random indirect effects and moderated mediation in multilevel models: New procedures and recommendations. Psychological Methods, 11(2), 142–163. http://doi.org/10.1037/1082-989X.11.2.142.CrossRefGoogle ScholarPubMed
Beavan, V. (2011). Towards a definition of ‘hearing voices’: A phenomenological approach. Psychosis, 3(1), 63–73. http://doi.org/10.1080/17522431003615622.CrossRefGoogle Scholar
Beavan, V., & Read, J. (2010). Hearing voices and listening to what they say: The importance of voice content in understanding and working with distressing voices. The Journal of Nervous and Mental Disease, 198(3), 201–205. http://doi.org/10.1097/NMD.0b013e3181d14612.CrossRefGoogle ScholarPubMed
Bell, I. H., Fielding-Smith, S. F., Hayward, M., Rossell, S. L., Lim, M. H., Farhall, J., & Thomas, N. (2019). Pilot randomised controlled trial of a brief coping-focused intervention for hearing voices blended with smartphone-based ecological momentary assessment and intervention (SAVVy): Feasibility, acceptability and preliminary clinical outcomes. Schizophrenia Research, 216, 479–487. https://doi.org/10.1016/j.schres.2019.10.026.CrossRefGoogle ScholarPubMed
Benjamin, L. S. (1989). Is chronicity a function of the relationship between the person and the auditory hallucination? Schizophrenia Bulletin, 15(2), 291–310. http://doi.org/10.1093/schbul/15.2.291.CrossRefGoogle ScholarPubMed
Birchwood, M., Gilbert, P., Gilbert, J., Trower, P., Meaden, A., Hay, J., … Miles, J. N. V. (2004). Interpersonal and role-related schema influence the relationship with the dominant ‘voice’ in schizophrenia: A comparison of three models. Psychological Medicine, 34(8), 1571–1580. http://doi.org/10.1017/S0033291704002636.CrossRefGoogle ScholarPubMed
Birchwood, M., Meaden, A., Trower, P., Gilbert, P., & Plaistow, J. (2000). The power and omnipotence of voices: Subordination and entrapment by voices and significant others. Psychological Medicine, 30(2), 337–344. http://doi.org/10.1017/S0033291799001828.CrossRefGoogle ScholarPubMed
Birchwood, M., Michail, M., Meaden, A., Tarrier, N., Lewis, S. W., Wykes, T., … Peters, E. R. (2014). Cognitive behaviour therapy to prevent harmful compliance with command hallucinations (COMMAND): A randomised controlled trial. The Lancet Psychiatry, 1(1), 23–33. http://doi.org/10.1016/S2215-0366(14)70247-0.CrossRefGoogle ScholarPubMed
Bolger, N., & Laurenceau, P.-J. (2013). Intensive longitudinal methods: An introduction to diary and experience sampling research. New York: The Guildford Press.Google Scholar
Bucci, S., Birchwood, M., Twist, L., Tarrier, N., Emsley, R., & Haddock, G. (2013). Predicting compliance with command hallucinations: Anger, impulsivity and appraisals of voices’ power and intent. Schizophrenia Research, 147(1), 163–168. http://doi.org/10.1016/j.schres.2013.02.037.CrossRefGoogle ScholarPubMed
Burnham, K. P., Anderson, D. R., & Anderson, R. P. (2004). Multimodel inference: Understanding AIC and BIC in model selection. Sociological Methods & Research, 33(2), 261–304. https://doi.org/10.1177/0049124104268644.CrossRefGoogle Scholar
Chadwick, P., & Birchwood, M. (1994). The omnipotence of voices: A cognitive approach to hallucinations. British Journal of Psychiatry, 164, 190–201. Retrieved from http://bjp.rcpsych.org/content/164/2/190.short.10.1192/bjp.164.2.190CrossRefGoogle ScholarPubMed
Chadwick, P., Lees, S., & Birchwood, M. (2000). The revised beliefs about voices questionnaire (BAVQ-R). British Journal of Psychiatry, 177(SEPT), 229–232. http://doi.org/10.1192/bjp.177.3.229.CrossRefGoogle Scholar
Chadwick, P., Strauss, C., Jones, A.-M., Kingdon, D., Ellet, L., Dannahy, L., & Hayward, M. (2016). Group mindfulness-based intervention for distressing voices: A pragmatic randomised controlled trial. Schizophrenia Research, 175, 168–175.CrossRefGoogle ScholarPubMed
Chaix, J., Ma, E., Nguyen, A., Ortiz Collado, M. A., Rexhaj, S., & Favrod, J. (2014). Safety-seeking behaviours and verbal auditory hallucinations in schizophrenia. Psychiatry Research, 220(1–2), 158–162. http://doi.org/10.1016/j.psychres.2014.08.041.CrossRefGoogle Scholar
Craig, T. K. J., Rus-Calafell, M., Ward, T., Leff, J. P., Huckvale, M., Howarth, E., … Garety, P. A. (2018). AVATAR therapy for auditory verbal hallucinations in people with psychosis: A single-blind, randomised controlled trial. The Lancet Psychiatry, 5, 31–40. http://dx.doi.org/10.1016/S2215-0366(17)30427-3.CrossRefGoogle ScholarPubMed
David, A. S. (2004). The cognitive neuropsychiatry of auditory verbal hallucinations: An overview. Cognitive Neuropsychiatry, 9(1–2), 107–123. http://doi.org/10.1080/13546800344000183.Google ScholarPubMed
Farhall, J., & Gehrke, M. (1997). Coping with hallucinations: Exploring stress and coping framework. The British Journal of Clinical Psychology/The British Psychological Society, 36(Pt 2), 259–261.CrossRefGoogle ScholarPubMed
Farhall, J., Greenwood, K. M., & Jackson, H. J. (2007). Coping with hallucinated voices in schizophrenia: A review of self-initiated strategies and therapeutic interventions. Clinical Psychology Review, 27(4), 476–493. http://doi.org/10.1016/j.cpr.2006.12.002.CrossRefGoogle ScholarPubMed
Fox, J. R., Gray, N. S., & Lewis, H. (2004). Factors determining compliance with command hallucinations with violent content: The role of social rank, perceived power of the voice and voice malevolence. Journal of Forensic Psychiatry & Psychology, 15(3), 511–531. http://doi.org/10.1080/1478994042000226741.CrossRefGoogle Scholar
Gilbert, P., Birchwood, M., Gilbert, J., Trower, P., Hay, J., Murray, B., … Miles, J. N. V. (2001). An exploration of evolved mental mechanisms for dominant and subordinate behaviour in relation to auditory hallucinations in schizophrenia and critical thoughts in depression. Psychological Medicine, 31(6), 1117–1127. http://doi.org/10.1017/S0033291701004093.CrossRefGoogle ScholarPubMed
Hacker, D., Birchwood, M., Tudway, J., Meaden, A., & Amphlett, C. (2008). Acting on voices: Omnipotence, sources of threat, and safety-seeking behaviours. British Journal of Clinical Psychology, 47(2), 201–213. http://doi.org/10.1348/014466507X249093.CrossRefGoogle ScholarPubMed
Haddock, G., McCarron, J., Tarrier, N., & Faragher, E. B. (1999). Scales to measure dimensions of hallucinations and delusions: The psychotic symptom rating scales (PSYRATS). Psychological Medicine, 29(4), 879–889. http://doi.org/10.1017/S0033291799008661.CrossRefGoogle Scholar
Hartley, S., Haddock, G., Vasconcelos e Sa, D., Emsley, R., & Barrowclough, C. (2015). The influence of thought control on the experience of persecutory delusions and auditory hallucinations in daily life. Behaviour Research and Therapy, 65, 1–4. http://doi.org/10.1016/j.brat.2014.12.002.CrossRefGoogle ScholarPubMed
Hayward, M. (2003). Interpersonal relating and voice hearing: To what extent does relating to the voice reflect social relating? Psychology and Psychotherapy, 76(Pt 4), 369–383. http://doi.org/10.1348/147608303770584737.CrossRefGoogle Scholar
Hayward, M, Berry, K, & Ashton, A. (2011). Applying interpersonal theories to the understanding of and therapy for auditory hallucinations. Clinical Psychology Review, 31, 1313–1323.CrossRefGoogle Scholar
Hayward, M, Denney, J, Vaughan, S, & Fowler, D. (2008). The Voice and You: Development and psychometric evaluation of a measure of relationships with voices. Clinical Psychology and Psychotherapy, 15, 45–52.CrossRefGoogle ScholarPubMed
Hayward, M., Edgecumbe, R., Jones, A.-M., Berry, C., & Strauss, C. (2018). Brief coping strategy enhancement for distressing voices: An evaluation in routine clinical practice. Behavioural and Cognitive Psychotherapy, 46, 226–237. http://doi:10.1017/S1352465817000388.CrossRefGoogle ScholarPubMed
Hayward, M., Jones, A.-M., Bogen-Johnston, L., Thomas, N., & Strauss, C. (2017). Relating therapy for distressing auditory hallucinations: A pilot randomized controlled trial. Schizophrenia Research, 183, 137–142.10.1016/j.schres.2016.11.019CrossRefGoogle ScholarPubMed
Howard, A., Forsyth, A., Spencer, H., Young, E. W., & Turkington, D. (2013). Do voice hearers naturally use focusing and metacognitive coping techniques? Psychosis, 5(2), 119–126. http://doi.org/Doi 10.1080/17522439.2012.668926.CrossRefGoogle Scholar
Larøi, F, Thomas, N, Aleman, A, Fernyhough, C, Wilkinson, S, Deamer, F, & McCarthy-Jones, S. (2018). The ice in voices: Understanding negative content in auditory verbal hallucinations. Clinical Psychology Review, 67, 1–10.10.1016/j.cpr.2018.11.001CrossRefGoogle ScholarPubMed
Larøi, F., Thomas, N., Aleman, A., Fernyhough, C., Wilkinson, S., Deamer, F., & McCarthy-Jones, S. (2019). The ice in voices: Understanding negative content in auditory-verbal hallucinations. Clinical Psychology Review, 67, 1–10.CrossRefGoogle ScholarPubMed
Longden, E., Corstens, D., Escher, S., & Romme, M. A. J. (2012). Voice hearing in a biographical context: A model for formulating the relationship between voices and life history. Psychosis, 4(3), 224–234. http://doi.org/10.1080/17522439.2011.596566.CrossRefGoogle Scholar
Mackinnon, A., Copolov, D. L., & Trauer, T. (2004). Factors associated with compliance and resistance to command hallucinations. The Journal of Nervous and Mental Disease, 192(5), 357–362. http://doi.org/10.1097/01.nmd.0000126728.70060.fa.CrossRefGoogle ScholarPubMed
Mallet, R. (1997). Sociodemographic schedule. London, UK: Section of Social Psychiatry, Institute of Psychiatry.Google Scholar
Mallinckrodt, C. H., Clark, W. S., & David, S. R. (2001). Accounting for dropout bias using mixed-effects models. Journal of Biopharmaceutical Statistics, 11(1–2), 9–21.CrossRefGoogle ScholarPubMed
Meaden, A., Keen, N., Aston, R., Barton, K., & Bucci, S. (2013). Cognitive therapy for command hallucinations: An advanced practical companion. Hove: Routledge.10.4324/9780203086544CrossRefGoogle Scholar
Michail, M, & Birchwood, M (2010) Command hallucinations: Theory and psychological interventions. In Hagen, R., Turkington, D. & Berge, T. (Eds.), CBT for psychosis: A symptom-based approach (pp. 99–115). New York, NY: Routledge.Google Scholar
Morrison, A. P. (1998). A cognitive analysis of the maintenance of auditory hallucinations: Are voices to schizophrenia what bodily sensations are to panic? Behavioural and Cognitive Psychotherapy, 26(1973), 289–302. Retrieved from http://journals.cambridge.org/abstract_S1352465898264010.CrossRefGoogle Scholar
Morrison, A. P., & Barratt, S. (2010). What are the components of CBT for psychosis? A Delphi study. Schizophrenia Bulletin, 36(1), 136–142. http://doi.org/10.1093/schbul/sbp118.CrossRefGoogle ScholarPubMed
Morrison, A. P., Nothard, S., Bowe, S. E., & Wells, A. (2004). Interpretations of voices in patients with hallucinations and non-patient controls: A comparison and predictors of distress in patients. Behaviour Research and Therapy, 42(11), 1315–1323. http://doi.org/10.1016/j.brat.2003.08.009.CrossRefGoogle ScholarPubMed
Myin-Germeys, I., Oorschot, M., Collip, D., Lataster, J., Delespaul, P., & van Os, J. (2009). Experience sampling research in psychopathology: Opening the black box of daily life. Psychological Medicine, 39(9), 1533–1547. http://doi.org/10.1017/S0033291708004947.CrossRefGoogle Scholar
Myin-Germeys, I., Peeters, F., Havermans, R., Nicolson, N. A., DeVries, M. W., Delespaul, P., & van Os, J. (2003). Emotional reactivity to daily life stress in psychosis and affective disorder: An experience sampling study. Acta Psychiatrica Scandinavica, 107(2), 124–131. https://doi.org/10.1034/j.1600-0447.2003.02025.x.CrossRefGoogle ScholarPubMed
Nayani, T. H., & David, A. S. (1996). The auditory hallucination: A phenomenological survey. Psychological Medicine, 26(1), 177. http://doi.org/10.1017/S003329170003381X.CrossRefGoogle ScholarPubMed
Nezlek, J. B. (2012). Diary methods for social and personality psychology. London: Sage.10.4135/9781446287903CrossRefGoogle Scholar
Palmier-Claus, J. E., Myin-Germeys, I., Barkus, E., Bentley, L., Udachina, A., Delespaul, P., … Dunn, G. (2011). Experience sampling research in individuals with mental illness: Reflections and guidance. Acta Psychiatrica Scandinavica, 123(1), 12–20. http://doi.org/10.1111/j.1600-0447.2010.01596.x.CrossRefGoogle Scholar
Peters, E. R., Lataster, T., Greenwood, K. E., Kuipers, E., Scott, J., Williams, S. L., … Myin-Germeys, I. (2012a). Appraisals, psychotic symptoms and affect in daily life. Psychological Medicine, 42(5), 1013–1023. http://doi.org/10.1017/S0033291711001802.CrossRefGoogle Scholar
Peters, E. R., Williams, S. L., Cooke, M. A., & Kuipers, E. (2012b). It's not what you hear, it's the way you think about it: Appraisals as determinants of affect and behaviour in voice hearers. Psychological Medicine, 42(7), 1507–1514. http://doi.org/10.1017/S0033291711002650.CrossRefGoogle Scholar
Reynold, N., & Scragg, P. (2010). Compliance with command hallucinations: The role of power in relation to the voice, and social rank in relation to the voice and others. Journal of Forensic Psychiatry & Psychology, 21(1), 121–138. http://doi.org/10.1080/14789940903194111.CrossRefGoogle Scholar
Romme, M. A. J., & Escher, S. (2000). Making sense of voices. London, UK: Mind.Google Scholar
Rucker, J., Newman, S., Gray, J., Gunasinghe, C., Broadbent, M., Brittain, P., … McGuffin, P. (2011). OPCRIT + : An electronic system for psychiatric diagnosis and data collection in clinical and research settings. British Journal of Psychiatry, 199(2), 151–155. http://doi.org/10.1192/bjp.bp.110.082925.CrossRefGoogle ScholarPubMed
Salkovskis, P. M. (1991). The importance of behaviour in the maintenance of anxiety and panic: A cognitive account. Behavioural Psychotherapy, 19(1), 6. http://doi.org/10.1017/S0141347300011472.CrossRefGoogle Scholar
Shawyer, F., Mackinnon, A., Farhall, J., Trauer, T., & Copolov, D. (2003). Command hallucinations and violence: Implications for detention and treatment. Psychiatry, Psychology and Law, 10(1), 97–107. http://doi.org/10.1375/pplt.2003.10.1.97.CrossRefGoogle Scholar
So, S. -W., Chung, L. -H., Tse, C. -Y., Chan, S. -M., Chong, G., Hung, K.-Y., & Sommer, I. E. C. (2020). Moment-to-moment dynamics between auditory verbal hallucinations and negative affect and the role of beliefs about voices. Psychological Medicine, 1–7. https://doi.org/10.1017/S0033291719003611.Google ScholarPubMed
StataCorp (2015). Stata Statistical Software: Release 14. 2015. College Station, TX: Stata Corporation. http://doi.org/10.2307/2234838.CrossRefGoogle Scholar
Stone, A. A., Shiffman, S., Atienza, A., & Nebeling, L. (2007). The science of real-time data capture: Self-reports in health research. New York: Oxford University Press.Google Scholar
Thomas, N., McLeod, H. J., & Brewin, C. R. (2009). Interpersonal complementarity in responses to auditory hallucinations in psychosis. The British Journal of Clinical Psychology/the British Psychological Society, 48(Pt 4), 411–424. http://doi.org/10.1348/014466509X411937.CrossRefGoogle ScholarPubMed
Thomas, N., Morris, E. M. J., Shawyer, F., & Farhall, J. (2013). Acceptance and commitment therapy for voices. In Morris, E. M. J., Johns, L. C. & Oliver, J. (Eds.), Acceptance and commitment therapy and mindfulness for psychosis. Chichester, England: Wiley, pp. 95–111.10.1002/9781118499184.ch7CrossRefGoogle Scholar
Trower, P., Birchwood, M., Meaden, A., Byrne, S., Nelson, A., & Ross, K. (2004). Cognitive therapy for command hallucinations: Randomised controlled trial. British Journal of Psychiatry, 184(APR.), 312–320. http://doi.org/10.1192/bjp.184.4.312.CrossRefGoogle ScholarPubMed
van der Gaag, M., Hageman, M. C., & Birchwood, M. (2003). Evidence for a cognitive model of auditory hallucinations. The Journal of Nervous and Mental Disease, 191(8), 542–545. http://doi.org/10.1097/01.nmd.0000082183.95853.ec.CrossRefGoogle ScholarPubMed
Varese, F., Morrison, A. P., Beck, R., Heffernan, S., Law, H., & Bentall, R. P. (2016). Experiential avoidance and appraisals of voices as predictors of voice-related distress. British Journal of Clinical Psychology, 55(3), 320–331. http://doi.org/10.1111/bjc.12102.CrossRefGoogle ScholarPubMed
Vaughan, S., & Fowler, D. G. (2004). The distress experienced by voice hearers is associated with the perceived relationship between the voice hearer and the voice. The British Journal of Clinical Psychology/The British Psychological Society, 43(Pt 2), 143–153. http://doi.org/10.1348/014466504323088024.CrossRefGoogle ScholarPubMed
Walls, T. A., Höppner, B. B., & Goodwin, M. S. (2007). Statistical issues in intensive longitudinal data analysis. In Stone, A.A., Shiffman, S., Atienza, A.A. & Nebeling, L. (Eds.), The science of real-time data capture: Self-reports in health research (pp. 338–360). Oxford University Press.Google Scholar