by Bradley Aldridge

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With many, if not most, academic articles finding themselves behind a paywall prohibitive to the average person interested in learning more about hearing voices from an academic perspective, and with many new articles being published constantly in a wide variety of journals providing a wide variety of opinions, it can be hard for the average voice-hearer to access the continually increasing pool of literature on the phenomenon which they themselves experience. With this in mind, I have selected six open access academic articles published within the past few months of 2019 that deal with the subject matter of voice hearing that anyone can read for free at any time.

AVATAR therapy: a promising new approach for persistent distressing voices

Tom K.J. Craig

Link to read the full article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313224/

The first article deals with AVATAR therapy, a type of therapy for voice-hearing that operates under the premise that “voices are best understood not simply as misattributions of internal thoughts, but represent hallucinated social entities that have personal relevance, meaning and purpose[.]” This understanding of voices leads AVATAR therapy to encourage voice-hearers to engage with their voices through the means of a computer generated avatar that is meant to be as close a replica as possible to a single one of the voices that the voice-hearer already hears, and in the process of engaging, to confront the avatar about derogatory patterns of relating between the voice (represented by the avatar) and the voice-hearer, and then change the relationship. The author concludes that while further study is needed to clarify the exact specifics of when AVATAR therapy is most helpful, “there is every reason to be optimistic” that AVATAR therapy will be able to be more widely implemented in the near future.

Compassion Focused Approaches to Working With Distressing Voices

Charles Heriot-Maitland, Simon McCarthy-Jones, Eleanor Longden, and Paul Gilbert

Link to read the full article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6367219/

This article deals with another type of therapy and its application for voice-hearing: compassion focused therapy. As the name implies, compassion focused therapy aims to use a compassionate approach towards helping people with a variety of life experiences, one of which can potentially be voice-hearing. The authors take the approach that “[t]here is a strong association between voice-hearing and childhood traumas […] meaning that many voice-hearers have, as children, experienced subordination to a dominant other […]. This is likely to have led to the development of highly sensitized threat-monitoring systems, especially for threats from dominant powerful others who may have malevolent intent.” The authors connect this to the dynamic between the voice-hearer and their voices, noting that “a common form of relating to voices, which involves feelings of being in relation to a more powerful figure […], as subordination to one’s voices is closely linked to experiences of subordination and marginalization in other social relationships […].” The proposed solution to this understanding of the origin of hearing voices is to replace the “hierarchical social organization” which may have played a role in creating and shaping the voice-hearing experience with “supportive and caring behaviour.” The article goes on to detail different aspects of how to foster this supportive, caring and compassionate environment, and some proposed strategies for dealing with voices themselves, concluding by contemplating whether the questions posed by this theoretical framework for understanding voices “can also provoke new questions to help us reconsider the nature of voice-hearing itself.”

Beyond Trauma: A Multiple Pathways Approach to Auditory Hallucinations in Clinical and Nonclinical Populations

Tanya Marie Luhrmann  Ben Alderson-Day  Vaughan Bell  Josef J Bless Philip Corlett  Kenneth Hugdahl  Nev Jones  Frank Larøi  Peter Moseley Ramachandran Padmavati  Emmanuelle Peters  Albert R Powers  Flavie Waters

Link to read the full article: https://academic.oup.com/schizophreniabulletin/article/45/Supplement_1/S24/5305662

This article is an article that most definitely picks up the challenge left behind in the conclusion of the above article, attempting to forge new pathways for how we understand voice-hearing and how we ought to understand it. Opening by acknowledging that “[t]he observation that trauma can play a significant role in the onset and maintenance of voice-hearing is one of the most striking and important developments in the recent study of psychosis[,]” the authors then go on to argue that “the finding that trauma increases the risk for hallucination and for psychosis is quite different from the claim that trauma is necessary for either to occur.” This theoretical framework leads the authors to seek out new ways of understanding voices, beyond either a purely biomedical model or a purely traumagenic one. What they identify are four patterns of voice-hearing experience: pattern I: “psychosis-like” presentation, pattern II: “trauma-related dissociation” presentation, pattern III: “simple trance” presentation, and pattern IV: “incidental” hallucinations. They come to the conclusion that while trauma can be one pathway to voice-hearing, this does not mean there are not other pathways as well.

Psychosocial characteristics differentiate non-distressing and distressing voices in 10,346 adolescents

Else-Marie Løberg, Rolf Gjestad, Maj-Britt Posserud, Kristiina Kompus, Astri J. Lundervold

Link to read the full article: https://link.springer.com/article/10.1007/s00787-019-01292-x

This study compares psychosocial factors in the voice-hearing experience of over ten thousand adolescents, coming to the conclusion that there are two distinct groups of voice-hearing adolescents, which they categorize as those who are distressed by the experience of voice-hearing and those who are not distressed. They identify that “[n]ot being disturbed by the voices was primarily related to social dysfunction, in addition to the experience of trauma, distractibility, affective symptoms, higher school grades, male gender and older age[,]” which is contrasted with the findings that “[p]erceiving the voices as disturbing was related to the experience of bullying and trauma, negative self-worth, and self-efficacy, less family support, dysregulation of activation, distractibility, self-harm, anxiety and younger age.” The authors additionally note that for the distressed group, “[n]egative self-worth was the strongest predictor.” The article ends with a hope that differentiating between those who are distressed and those who are not distressed by their voice hearing experience “may aid referral practices and treatment decisions in services for psychosis or high risk for psychosis.”

Metaphor framing and distress in lived-experience accounts of voice-hearing

Zsófia Demjén, Agnes Marszaleka, Elena Seminoc and Filippo Varese

Link to read the full article: https://www.tandfonline.com/doi/pdf/10.1080/17522439.2018.1563626?needAccess=true

This study employs linguistic analysis of metaphors as a methodology for understanding the voice-hearing experience. The authors begin by noting the diversity of voice-hearing experiences and suggest that “[d]istress is generally not caused by the mere presence of voices, but depends on: what the voices say, and how; the relationship that voice-hearers establish with their voices; how voice-hearers make sense of their voices and their perception of the “power” of the voices; voice-hearers’ perceived control over the voices and their ability to control important aspects of their lives[.]” The authors opt for the relatively unusual route of analyzing the metaphors voice-hearers use to describe their own voice-hearing experience to help determine what factors might play a role in the presence or absence of distress. The conclusion they come to is this: “different metaphors, even conventional and semitechnical ones, frame the experience of voice-hearing in particular ways in terms of agency and (dis)empowerment, and how this correlates with varying degrees of distress in our sample. We reported that, in our data, people who constructed themselves as disempowered and the voice as empowered – through, particularly creative, Violence, Movement, or Full Container metaphors, for example – were more likely to be distressed by their voices. This was linked to the broader notion of control, specifically the absence thereof. Of course, numerous contextual and social factors influence individuals’ specific choice of metaphor in a given situation. However, the framing effects produced by different metaphors are less variable in this sense, given that the same framing effect (e.g. in terms of (dis)empowerment) can be suggested by many different metaphors[.]”

Personal growth in psychosis

Mike Slade, Laura Blackie, and Eleanor Longden

Link to read the full article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313249/

The final article I have chosen to highlight is a brief, and perhaps even generic article to those familiar with the Hearing Voices Movement and associated theoretical frameworks, but nonetheless contains a message that is still held to be important by many. This message would be that: “even the most devastating periods of mental ill‐health can ultimately be a source of personal development.” Voice-hearing, it is suggested, can lead to, “a greater capacity for political activism, emotional insight, creativity, courage, and compassion for self and others.” The article discusses posttraumatic growth, noting that trauma is “both a cause […] and effect of psychosis,” and detailing some of the ways in which voice-hearers can grow both from the traumatic experiences which may or may not have prompted their voice-hearing in the first place, and from what can be the trauma of voice-hearing itself. The article concludes that “[t]he expertise of organizations such as the HVM may be needed in the mental health system[,]” a bold statement, yet an encouraging one, for as much as it is beneficial for researchers to seek to untangle the mechanisms behind the diverse and complex experience of voice-hearing, it is equally beneficial for voice-hearers to seek to share their expertise of lived experience of those who would seek to understand this deeply complicated and deeply human experience.

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