This report from the International Consortium on Hallucinations Research considers the current status and future directions in research on psychological therapies targeting auditory hallucinations (hearing voices). Therapy approaches have evolved from behavioral and coping-focused interventions, through formulation-driven interventions using methods from cognitive therapy, to a number of contemporary developments. Recent developments include the application of acceptance- and mindfulness-based approaches, and consolidation of methods for working with connections between voices and views of self, others, relationships and personal history. In this article, we discuss the development of therapies for voices and review the empirical findings. This review shows that psychological therapies are broadly effective for people with positive symptoms, but that more research is required to understand the specific application of therapies to voices. Six key research directions are identified: (1) moving beyond the focus on overall efficacy to understand specific therapeutic processes targeting voices, (2) better targeting psychological processes associated with voices such as trauma, cognitive mechanisms, and personal recovery, (3) more focused measurement of the intended outcomes of therapy, (4) understanding individual differences among voice hearers, (5) extending beyond a focus on voices and schizophrenia into other populations and sensory modalities, and (6) shaping interventions for service implementation.

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The experience of hearing voices (auditory hallucinations) has been construed as that of relating to an interpersonal 'other'. This preliminary study utilized Birtchnell's (1996, 2002) theory of relating to investigate the hypothesis that people who hear voices relate to the voices and to people within their social environment in similar ways. A correlational design was adopted and 27 people provided information about the characteristics of their voice-hearing experience, relating to the voice and relating socially. Significant correlations were found between relating to the voice and relating socially in terms of the 'dominant' and 'submissive' forms of power and the 'clinging' form of proximity: these associations were independent of beliefs about the voices and mood-linked appraisals. However, relating from a position of 'withdrawal' was found to be unique to the experience of voice hearing, and was most extreme when relating to voices that were perceived to have no identity. This study offers further evidence in support of the hypothesis that people who hear voices relate to them in ways that reflect more pervasive patterns of social relating. The clinical implications of these findings for assessment and intervention are discussed.

The phenomenological diversity of auditory verbal hallucinations (AVH) is not currently accounted for by any model based around a single mechanism. This has led to the proposal that there may be distinct AVH subtypes, which each possess unique (as well as shared) underpinning mechanisms. This could have important implications both for research design and clinical interventions because different subtypes may be responsive to different types of treatment. This article explores how AVH subtypes may be identified at the levels of phenomenology, cognition, neurology, etiology, treatment response, diagnosis, and voice hearer’s own interpretations. Five subtypes are proposed; hypervigilance, autobiographical memory (subdivided into dissociative and nondissociative), inner speech (subdivided into obsessional, own thought, and novel), epileptic and deafferentation. We suggest other facets of AVH, including negative content and form (eg, commands), may be best treated as dimensional constructs that vary across subtypes. After considering the limitations and challenges of AVH subtyping, we highlight future research directions, including the need for a subtype assessment tool.

Group Person-Based Cognitive Therapy (PBCT) integrates cognitive therapy and mindfulness to target distinct sources of distress in psychosis. The present study presents data from the first randomised controlled trial investigating group PBCT in people distressed by hearing voices. One-hundred and eight participants were randomised to receive either group PBCT and Treatment As Usual (TAU) or TAU only. While there was no significant effect on the primary outcome, a measure of general psychological distress, results showed significant between-group post-intervention benefits in voice-related distress, perceived controllability of voices and recovery. Participants in the PBCT group reported significantly lower post-treatment levels of depression, with this effect maintained at six-month follow-up. Findings suggest PBCT delivered over 12 weeks effectively impacts key dimensions of the voice hearing experience, supports meaningful behaviour change, and has lasting effects on mood.

Self-harm is a prevalent phenomenon regularly faced by doctors and nurses working in accident and emergency (A&E) departments. We argue that the treatment decisions A&E doctors make are fundamental to decreasing the high risk of suicide among this group. In this article we present a qualitative study exploring how doctors working in A&E respond to treating people who self-harm. In total, five A&E doctors were interviewed and the data were analyzed using interpretative phenomenological analysis. Three main themes were extracted: treating the body, silencing the self, and mirroring cultural and societal responses to self-harm. Within these themes, we identified both facilitative and unhelpful aspects of the relationships between people who self-harm and A&E doctors. We consider the clinical implications of these findings within the context of A&E doctors having limited opportunities to address the relational nature of the care they offer to this group.

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The experience of hearing voices has recently been conceptualized within a relational framework. Birtchnell's Relating Theory offers a framework capable of exploring the power and intimacy within the relationship between the hearer and the voice. However, measures of relationships with voices derived from the theory, such as the Hearer to Voice (HTV) and Voice to Hearer (VTH) by Vaughan and Fowler, have lacked robust psychometric properties. Data were available from 71 participants who completed the HTV and VTH, and analysis of these data generated a new 29-item measure, the Voice and You (VAY), capable of assessing the 'interrelating' between the hearer and the voice. The VAY was completed by a further 30 participants and was found to be internally consistent, stable over time and associated with other measures of the voice-hearing experience. The VAY offers a psychometrically stable measure of the relationship between the hearer and the voice. It may be used as an adjunct to the clinical interview and/or a measure of outcome.