This month in voices: May 2013

Loads more papers on voices published in May…


BirminghamBirmingham, UK. Connor and Birchwood look at self-critical thoughts and the self-
reassuring capacity in people who hear voices, and how this relates to what their voices are like.

Accessible summary: The study found that people who heard voices which had content involving themes of shame had a reduced capacity to self-reassure themselves after self-critical thoughts. Furthermore, voice-hearers with the greatest level of self-critical thoughts (involving self-hatred and inadequacy) were found to view their voices as powerful and to have voices which were critical and hostile (i.e.,  had high ‘expressed emotion’).  The authors note that, given these findings, Compassionate Mind Training, which aims to reduce levels of self-critical thoughts and increase feelings of self-reassurance and acceptance, may help people who hear voices.

Link to paper (free to read):


Newcastle2Newcastle, UK. Milligan and colleagues (including me) examine how voices change over time.

Accessible summary. This study looked at how voices changed over time in people who were in an Early Intervention for Psychosis service. We found that six themes emerged as part of people’s hearing voices journey. Voices typically emerged after negative life events and were at first rejected as being part of the self. Crisis events could then lead to either positive changes (e.g., the voice-hearer opening up to talking to their friends and services about their voices) or negative ones (e.g., voices becoming more critical/abusive). Voice-hearers could enter a phase involving discovering, adjusting and trying to cope with the voices, based on three key resources: themselves, others, and services. Finally, a “New Understanding” phase could be reached where participants changed from simply rejecting their voices to different understandings, such as that their voices were a part of them, and were potentially there for the long-term. The stages we found didn’t match with the three phases previously proposed by Romme and Escher, but this could have been due to the specific early stage that many of the voice-hearers in this study were at.

Link to paper (or email me for a copy):


Birmingham2Birmingham, UK. Connor and Birchwood publish another study, this time looking at the relation between the perceived power of voices (and their critical/hostile nature) and depression/suicidal thinking in voice-hearers.

Accessible summary: This study found that 78% of voice-hearers who had voices which they perceived to be powerful, and hostile/critical voiced, had significantly elevated levels of depression. People who rated their voices as emotionally supportive showed the lowest levels of depression and suicidal thinking. The authors conclude that many of the talking therapies that are routinely used to help depressed people with relationship difficulties should be helpful to people who hear voices. They also note that the supportive aspect of the voice hearer with their voices should not be undermined if the voice-hearer doesn’t have any other supportive social network.

Link to paper (free to read):


Warwick3Warwick, UK. Noorani examines service-user involvement, including the Hearing Voices Movement, in mental health services.

Accessible summary: This interesting paper looks at how the radical survivor movement has transformed into the service user movement.  The new experiential authority of ‘experts-by-experience’ is examined, and it is considered how the resultant knowledge is able to contest the knowledge and authority
of medical psychiatry. (It is likely to be informative to compare this paper with the great blogs of Nev Jones, available via

Link to paper:


london5London, UK. Hepworth and colleagues examine whether people diagnosed with schizophrenia respond to their voices differently compared to people diagnosed with borderline personality disorder (BPD).

Accessible summary: The study looked at how people diagnosed with BPD differ in their psychological responses to hearing voices, as compared to people diagnosed with psychosis. They found that both groups of people held similar levels of beliefs about the omnipotence and malevolence of their most dominant voice. However, people diagnosed with BPD were found to report that their dominant voice had a more
negative impact. The authors note that this is consistent with previous research which found that, for those with BPD, voices are experienced as more distressing and
have greater levels negative content than for the voices heard by people diagnosed with schizophrenia (on average). They suggets that the higher level of child sexual abuse found in the group of people diagnosed with BPD , compared to the group of people diagnosed with schizophrenia, could explain the difference, i.e., the dominant voice in the BPD group may be more likely to be that of an abuser, and hence cause greater distress.

Link to paper:


London6London, UK: Howard and colleagues examine how people try to cope with their voices.

Accessible summary: This study looked to see how people naturally coped with their voices. The majority of voice-hearers were found to either cope with their voices through distraction or a form of non-engagement. Only 20% of voice-hearers used what could be termed “engagement strategies” such as focusing on the characteristics of the voice, and talking back to the voice on the mobile telephone. The authors conclude that “coping strategies naturally utilised by voice hearers tend to be of limited benefit and may perpetuate the voice hearing experience”.

Link to paper:


Other studies

Plenty on transcranial magnetic stimulation (TMS). Hoffman and colleagues find further evidence that  may help some voice-hearers. Link to paper here. Kindler and colleagues find that a variant of TMS, specifically theta burst stimulation, can help some voice-hearers. Link here. Plus, more on TMS from Hubl and Dierks colleagues. Link here.

Hugdahl and colleagues find hearing voices interferes with the ability to attend to the outer world. They note it should be possible to “cognitively train AVH patients to learn to re-focus attention away from the “voices” and to cognitively inhibit such experiences (contrast with Howard et al study about). Link here.

Jardri and colleagues publish an interesting paper about the relation between temporal instabilities of the default mode network and hallucinations in general. Link here.

Kim and colleagues find a variation (rs4773092) in the IRS1 gene (insulin receptor substrate 2) to be associated with auditory hallucinations. Link here.

Koeda and colleagues examines the neural activation associated with perceptions of greetings, in people who hear voices. Link here.

Orr and colleagues find that giving nursing students simulated sounds and voices to listen to (recorded by consumers on mp3 players) during a task helped them develop an understanding of voice-hearing, increased their awareness of its impact on functioning, and helped them consider the communication skills necessary to engage with consumers who hear voices. Link to paper here.

Stephane highlights the importance of the phenomenology of hearing voices. Link to paper (free to access) here.

I think that’s enough for one month. Well, maybe one more quick paper – here’s an article by myself and Eleanor Longden, free to read.

More soon!



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