Bringing the “self” into focus: conceptualising the role of self-experience for understanding and working with distressing voices

Abstract

A primary goal of cognitive behavior therapy for psychosis (CBTp) is to reduce distress and disability, not to change the positive symptoms of psychosis, such as hearing voices. Despite demonstrated associations between beliefs about voices and distress, the effects of CBTp on reducing voice distress are disappointing. Research has begun to explore the role that the psychological construct of “self” (which includes numerous facets such as self-reflection, self-schema and self-concept) might play in causing and maintaining distress and disability in voice hearers. However, attempts to clarify and integrate these different perspectives within the voice hearing literature, or to explore their clinical implications, are still in their infancy. This paper outlines how the self has been conceptualised in the psychosis and CBT literatures, followed by a review of the evidence regarding the proposed role of this construct in the etiology of and adaptation to voice hearing experiences. We go on to discuss some of the specific intervention methods that aim to target these aspects of self-experience and end by identifying key research questions in this area. Notably, we suggest that interventions specifically targeting aspects of self-experience, including self-affection, self-reflection, self-schema and self-concept, may be sufficient to reduce distress and disruption in the context of hearing voices, a suggestion that now requires further empirical investigation.

Testing the Interpersonal-Cognitive Model of Auditory Verbal Hallucinations in Youths with Either Early-Stage Borderline Personality Disorder or First-Episode Schizophrenia Spectrum Disorder

“…Further, it is in line with the assumptions that voices are experienced as social, person-like entities with whom the voice hearer has a relationship [61] and that the same rules that govern social relationships also govern the relationship with voices [18,25]. Finally, it is consistent with a reciprocal understanding of the relationship between voices and the self [59,62,63]. Indeed, Strauss [p. 1374 in 64] recently pointed out the possibility that "rather than beliefs about voice power arising out of preexisting interpersonal schema laid down in early childhood, it may be the case that interpersonal schema concerning power alter in the context of hearing voices or indeed that beliefs about voice power have an impact on interpersonal schema."…”

Immersion in altered experience: An investigation of the relationship between absorption and psychopathology

“…Likewise, often there is only a suboptimal response to antipsychotic medications leaving residual symptoms such as hallucination and delusions active. An orientation to absorption rather than the more cognitive mechanisms of psychosis may suggest that value of approaches that focus on embodied states (or the embodiment of emotions), mindfulness and awareness of self and world (Fielding-Smith et al, 2015; Stanghellini & Lysaker, 2007; Lysaker & Dimaggio, 2014). In addition, the quasi-agentive nature of absorption further underscores the potential clinical importance of greater attention to the role of agency in the subjective experience of psychosis and the clinical implications of agentive processes (Jones et al, 2016).…”

Exploration of the dialogue components in Avatar Therapy for schizophrenia patients with refractory auditory hallucinations: A content analysis

“…Disturbances in self-experience has been shown to represent practical targets in voice hearers (McCarthy-Jones, Marriott, Knowles, Rowse, & Thompson, 2013). Self-concept components have been linked to voice content, appraisals of power as well as emotional (e.g., distress) and behavioural responses to voices (Fielding-Smith et al, 2015). Moreover, besides the patients' selfperceptions, the way they perceive their voices plays a role on their emotions and felt distress (Chadwick & Birchwood, 1994;Mawson, Cohen, & Berry, 2010).…”