Distress Linked to the Quantity and Quality of Auditory Hallucinations

Individuals who experience auditory hallucinations are more likely to develop psychosis, schizophrenia, or other significant mental health problems than those who don’t. Most auditory hallucinations take the form of voices and can be perceived as either harmful or helpful. Some people who hear voices describe the voices as being omnipotent and powerful. The type of voice hearing can lead to intense psychological distress. Other voice hearers report less omnipotence but clearer intent. These individuals describe the voices as perhaps not as powerful but specific in their objective, either to cause harm (malevolent) or to be helpful (benevolent). Understanding how activity or intent relates to the level of psychological distress is important for clinicians who work with individuals at risk for psychosis.

Emmanuelle R. Peters, of the Department of Psychology at King’s College in London, recently led a study to determine what aspect of voice hearing most influenced psychological distress. For his study, Peters assessed 46 individuals with a history of voice hearing using the Beliefs About Voices Questionnaire—Revised. He looked specifically at the power of the voices (omnipotence), the intent (benevolent or malevolent), and the way in which these aspects affected the behavior of the individuals through either engagement with the voices or resistance to them.

Peters found that power was the strongest predictor of psychological distress in the participants, regardless of the intent of the voices heard. However, intent directly influenced the participants’ behavior. In this regard, participants engaged with benevolent voices but tended to resist the malevolent voices. Peters said, “Thus, voice hearers tend to act in accordance with their beliefs about the voices’ intentions towards them, but their distress is related to how powerful they consider their voices to be.” Peters also discovered that by itself, the frequency of voice hearing was unrelated to psychological distress in the participants. The study also revealed that how voices were perceived, thus the belief related to the voices, was the primary predictor of distress manifested in many forms, including anxiety, decreased self-esteem, depression, and even thoughts of suicide. For clinicians, these results present evidence that the appraisal of voices is a core element of the behavioral outcome in those who hear voices.

Peters, E. R., Williams, S. L., Cooke, M. A., Kuipers, E. (2012). 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.

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  • Kellen

    June 11th, 2012 at 3:37 PM

    It must be so frightening to begin hearing these voices and to really believe that this is a voice that has such a strong power and pull over this person. Mental illness is something that very few of us understand, but more studies like this can lead us to a greater understanding and treatment of these patients in need.


    June 11th, 2012 at 5:48 PM

    Quantity of hallucinations- I get that- the number of hallucinations someone has. But quality? Does that mean like how real it seems to the person?

  • wallace

    June 12th, 2012 at 4:20 AM

    I am surprised that so many of these patients who do report hearing voices are lucid enough to particiapte in this study and provide researchers with a realistic look into the hallucinations and the things that they experience within. It must often be difficult to sort through the information that is offered via conversations with these patients, as I am sure it is common for them to have difficulty to remember the experience or to actaully be able to put into words how they felt at that time. This new research will hopefully spur on more findings in this area which can be so critical for developing treatment plans and maybe even cures later on.

  • Sunshine

    June 12th, 2012 at 5:54 PM

    This is the first time I am reading details about hearing voices(as opposed to noises) and yes it sure seems like a very frightening thing to hear.And its surprising how there are variances in the voices heard and their effects.

    But whatever it is,even if the voice is of a desirable levels with benevolent qualities,it is still harmful to the patient,isn’t it?

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