Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-22T16:49:12.911Z Has data issue: false hasContentIssue false
  • English
  • Français

The Omnipotence of Voices

A Cognitive Approach to Auditory Hallucinations

Published online by Cambridge University Press:  02 January 2018

Paul Chadwick  and
Max Birchwood
Paul Chadwick*
Affiliation:
University of Birmingham, and Clinical Psychologist, The Archer Centre, All Saints' Hospital, Lodge Road, Birmingham B18 5SD
Max Birchwood
Affiliation:
All Saints' Hospital, Birmingham, and Professor of Psychology, University of Birmingham
*
∗Correspondence
Get access Rights & Permissions [Opens in a new window]

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.

Type
Papers
Information
The British Journal of Psychiatry , Volume 164 , Issue 2 , February 1994 , pp. 190 - 201
Copyright
Copyright © 1994 The Royal College of Psychiatrists 

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

American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.Google Scholar
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.Google Scholar
Beck, A. T., Rush, A. J., Shaw, B. F., et al (1979) Cognitive Therapy of Depression. New York: Guilford.Google Scholar
Benjamin, L. S. (1989) Is chronicity a function of the relationship between the person and the auditory hallucination? Schizophrenia Bulletin, 15, 291–310.10.1093/schbul/15.2.291CrossRefGoogle ScholarPubMed
Birchwood, M. J. (1986) Control of auditory hallucinations using earplugs through occlusion of monaural auditory input. British Journal of Psychiatry, 149, 104–107.10.1192/bjp.149.1.104Google Scholar
Birchwood, M. J. & Tarrier, N. (1992) Innovations in the Psychological Management of Schizophrenia. Chichester: Wiley.Google Scholar
Brett-Jones, J., Garety, P. A. & Hemsley, D. R. (1987) Measuring delusional experiences: a method and its application. British Journal of Clinical Psychology, 26, 257–265.10.1111/j.2044-8260.1987.tb01359.xCrossRefGoogle ScholarPubMed
Brier, A. & Strauss, J. S. (1983) Self control in psychiatric disorders. Archives of General Psychiatry, 40, 1141–1145.10.1001/archpsyc.1983.01790090103016CrossRefGoogle Scholar
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.Google Scholar
Chadwick, P. D. J. & Lowe, C. F. (1990) Measurement and modification of delusional beliefs. Journal of Consulting and Clinical Psychology, 58, 225–232.10.1037/0022-006X.58.2.225Google Scholar
Chadwick, P. D. J. & Birchwood, M. J. (1994) Cognitive Therapy for Delusions and Hallucinations. Chichester: Wiley. (In press.) Google Scholar
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.Google Scholar
Falloon, I. R. H. & Talbot, R. E. (1981) Persistent auditory hallucinations: coping mechanisms and implications for management. Psychological Medicine, 11, 329–339.10.1017/S0033291700052144CrossRefGoogle ScholarPubMed
Fowler, D. & Morley, S. (1989) The cognitive behavioural treatment of hallucinations and delusions: a preliminary study. Behavioural Psychotherapy, 17, 267–282.10.1017/S0141347300016700CrossRefGoogle Scholar
Gilbert, P. (1984) Depression: From Psychology to Brain State. London: Lawrence Erlbaum Associates.Google Scholar
Hibbert, G. A. (1984) Ideational components of anxiety: their origins and content. British Journal of Psychiatry, 144, 618–624.10.1192/bjp.144.6.618CrossRefGoogle ScholarPubMed
Kingdon, D. G. & Turkington, D. (1991) The use of cognitive behaviour therapy with a normalising rationale in schizophrenia. Journal of Nervous Disease, 179, 207–211.10.1097/00005053-199104000-00005CrossRefGoogle ScholarPubMed
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.Google Scholar
Markova, I. S. & Berrios, G. E. (1992) The meaning of insight in clinical psychology. British Journal of Psychiatry, 160, 850–860.10.1192/bjp.160.6.850CrossRefGoogle Scholar
Miligram, S. (1974) Obedience to Authority. New York: Harper & Row.Google Scholar
Parkinson, B. & Manstead, A. S. R. (1992) Appraisal as a cause of emotion. In Emotion (ed. Clarke, M.). London: Sage.Google Scholar
Romme, M. A. J. & Escher, A D. M. A. C. (1989) Hearing voices. Schizophrenia Bulletin, 209–217.CrossRefGoogle Scholar
Slade, P. & Bentall, R. P. (1988) Sensory Deception: A Scientific Analysis of Auditory Hallucinations. Chichester: Wiley.Google Scholar
Strauss, J. S. (1989) Subjective experience of schizophrenia. Schizophrenia Bulletin, 15, 179–188.10.1093/schbul/15.2.179CrossRefGoogle ScholarPubMed
Tarrier, N. (1987) An investigation of residual positive symptoms in discharged schizophrenic patients. British Journal of Clinical Psychology, 26, 141–143.10.1111/j.2044-8260.1987.tb00740.xCrossRefGoogle Scholar
Tennen, H. & Affleck, G. (1990) Blaming others for threatening events. Psychological Bulletin, 108, 209–232.10.1037/0033-2909.108.2.209CrossRefGoogle Scholar
Vygotsky, L. S. (1962) Thought and Language. Cambridge, MA: Harvard University Press.10.1037/11193-000CrossRefGoogle Scholar
Yalom, I. (1970) The Theory and Practice of Group Psychotherapy. New York: Basic Books.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.