Interpersonal and role-related schema influence the relationship with the dominant ‘voice’ in schizophrenia: a comparison of three models

  title={Interpersonal and role-related schema influence the relationship with the dominant ‘voice’ in schizophrenia: a comparison of three models},
  author={Max Birchwood and Paul Gilbert and Jean Gilbert and Peter Edward Trower and Alan Meaden and Justin Hay and Eleanor J Murray and Jeremy Miles},
  journal={Psychological Medicine},
  pages={1571 - 1580}
Background. Auditory hallucinations in psychosis often contain critical evaluations of the voice-hearer (for example, attacks on self-worth). A voice-hearer's experience with their dominant voice is a mirror of their social relationships in general, with experiences of feeling low in rank to both voices and others being associated with depression. However, the direction of the relationship between psychosis, depression and feeling subordinate is unclear. Method. Covariance structural equation… 

Echoes of others: A path analytic examination of an interpersonal–cognitive model of voice‐related distress

Support is added to the suggestion that voice-related distress occurs in the context of an insecure attachment style and negative core beliefs about self and others, as well as to the proposal that attachment anxiety/avoidance drive negative beliefs aboutSelf and others.

The role of social schema in the experience of auditory hallucinations: a systematic review and a proposal for the inclusion of social schema in a cognitive behavioural model of voice hearing.

  • G. Paulik
  • Psychology
    Clinical psychology & psychotherapy
  • 2012
A systematic literature review of relevant studies was undertaken, including those that investigated how social processes interact with appraisals of voices, as well as affective and behavioural responding to voices, finding two well-replicated findings.

Power and perceived expressed emotion of voices: their impact on depression and suicidal thinking in those who hear voices.

Analysis of the relationship between power and EE revealed that many voices perceived as low in power were, nevertheless, perceived as high in EE, highlighting the protective role that the supportive dimension of the voice/voice-hearer relationship may have.

Beyond the omnipotence of voices: further developing a relational approach to auditory hallucinations

Auditory hallucinations (“voices”) can be understood within a cognitive model whereby the beliefs an individual holds about their voices influences their level of distress and how they respond to

Interpersonal complementarity in responses to auditory hallucinations in psychosis.

Individual differences in responses to auditory hallucinations appear to reflect normal interpersonal responses to appraisals of voice hostility and affiliation, however, voice hearers do not readily submit to voice control and other factors may be of importance in determining this response.

A relationship of sorts: gender and auditory hallucinations in schizophrenia spectrum disorders

Although basic phenomenological characteristics of voices were similar in both genders, women showed greater amounts of distress caused by the voices and reported a persistence of voices for longer time periods, therapeutic concepts that strengthen instrumental/agentic traits could be a feasible target for psychotherapeutic interventions in voice hearing, especially in women.

Compliance with command hallucinations: the role of power in relation to the voice, and social rank in relation to the voice and others

This study examined three factors hypothesised which influence compliance to harm-others command hallucinations. The factors investigated were the perceived power of the commanding voice,

The origins of voices: links between life history and voice hearing in a survey of 100 cases

A data synthesis is presented from 100 clinical cases, 80% with a diagnosis of schizophrenia or other psychotic disorder, in which Romme and Escher’s “construct” method was used to formulate



The power and omnipotence of voices: subordination and entrapment by voices and significant others

This study suggests that the power imbalance between the individual and his persecutor(s) may have origins in an appraisal by the individual of his social rank and sense of group identification and belonging.

Cognitive assessment of voices: further developments in understanding the emotional impact of voices.

Compared to the previous study, current participants were significantly less likely to believe in the omnipotence of their voices, to view their voices as omniscient and to have a positive affective response to benevolent voices.

An exploration of evolved mental mechanisms for dominant and subordinate behaviour in relation to auditory hallucinations in schizophrenia and critical thoughts in depression

Evidence is presented that schizophrenic, malevolent voice hearers and self-critical depressed people experience their hostile, internally generated voices/thoughts as powerful, dominating and controlling (i.e. have typical characteristics of a hostile dominant) and these are associated with depression in both depression and schizophrenia.

The auditory hallucination: a phenomenological survey.

A pattern emerged of increasing complexity of the auditory–verbal hallucination over time by a process of accretion, with the addition of more voices and extended dialogues, and more intimacy between subject and voice, which seemed to relate to the lessening of distress and improved coping.

Is chronicity a function of the relationship between the person and the auditory hallucination?

Thirty psychiatric inpatients each rated their relationship with their auditory hallucination using the Structural Analysis of Social Behavior questionnaires which assess partnerships in terms of interpersonal focus, love-hate, and enmeshment-differentiation, suggesting that the relationship with the hallucination may serve an adaptive function.

Evidence for a Cognitive Model of Auditory Hallucinations

The authors suggest that the voice experience in itself is enough to provoke negative affect within participants, even when the content is benevolent, and improve the assessment of the voice content by using two raters to independently assess voice content.

Independent course of childhood auditory hallucinations: A sequential 3-year follow-up study

Need for care in the context of experience of voices is associated with appraisal of the voices in terms of intrusiveness and ‘omnipotence’, suggesting that experience of Voices by children should be the target of specific interventions.

Evidence that three dimensions of psychosis have a distribution in the general population

The data suggest that the correlated dimensions of clinical psychosis also have a distribution in the general population, and that depressive symptoms may form an integral part of psychosis-like experiences in thegeneral population.

The Omnipotence of Voices II: the Beliefs About Voices Questionnaire (BAVQ)

The BAVQ was found to be easy to complete and the scale may aid clinical assessment of voices, not least because of the possible value of cognitive therapy as a treatment approach.

Challenging the omnipotence of voices: group cognitive behavior therapy for voices.