Background: Visual hallucinations (VH) are a common experience and can be distressing and disabling, particularly for people suffering from psychotic illness. However, not everyone with visual hallucinations reports the experience to be distressing. Models of VH propose that appraisals of VH as a threat to wellbeing and the use of safety seeking behaviours help maintain the distress. Aims: This study investigated whether people with distressing VH report threat appraisals and use safety behaviours. Method: The study utilized a single group descriptive design, in which 15 participants with psychosis and VH were asked questions in order to assess the content, distress, appraisals, and behaviours associated with visual hallucinations. Results: People who found visual hallucinations distressing (n = 13) held negative appraisals about those hallucinations and specifically saw them as a threat to their physical or psychological wellbeing. They also engaged in safety seeking behaviours that were logically related to the appraisal and served to maintain the distress. Conclusions: People with distressing VH regard them as a threat to their wellbeing and use safety seeking behaviours as a result of this perceived threat. These key processes are potential targets for treatments that will alleviate the distress associated with VH.

Paralleling developments in other areas of clinical psychology, psychological theories of chronic pain have evolved from the purely behavioural models of several decades ago, to those that have increasingly recognized the importance of cognitive constructs (without necessarily neglecting the influence of behavioural factors that remains significant). As is well established in the domains of anxiety and depression, pain related cognitions and coping strategies are now considered to be just as, if not more, important as behavioural constructs such as reinforcement contingencies. At the same time, however, some of the exciting developments in other clinical areas have only just begun to receive due attention from those interested in pain. In particular, the “safety seeking behaviours” construct, which has received a considerable amount of attention in recent years from anxiety researchers, appears to have been virtually ignored by those researching pain. Although related constructs such as “fear avoidance” have increasingly been recognized and investigated, specific reference to safety behaviours (in relation to pain) does not seem to have occurred. This paper presents a brief overview of how the concept of safety seeking behaviours could be applied to chronic pain patients. Although not advancing a radically new approach, it is argued that there are theoretical and clinical advantages to integrating safety seeking behaviours in to psychological models of pain.