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

Abstract

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 modelling was used with data from 125 participants diagnosed with schizophrenia to compare three ‘causal’ models: (1) that depression leads to the appraisal of low social rank, voice power and distress; (2) that psychotic illness leads to voice activity (frequency, audibility), which in turn leads to depression and the appraisal of voices' power; (3) our hypothesized model, that perceptions of social rank and social power lead to the appraisal of voice power, distress and depression.Results. Findings supported model 3, suggesting that the appraisal of social power and rank are primary organizing schema underlying the appraisal of voice power, and the distress of voices.Conclusions. Voices can be seen to operate like external social relationships. Voice content and experience can mirror a person's social sense of being powerless and controlled by others. These findings suggest important new targets for intervention with cognitive and social therapy.

Use of an avatar in cognitive-behavioural therapy of a person who is chronically experiencing negative auditory hallucinations – case study

“…Plan opisanej terapii został opracowany z uwzględnie-niem czterech źródeł teoretycznych: (1) poznawczo-behawioralnego podejścia do objawów psychotycznych [9, 10], (2) poznawczej teorii omamów słuchowych [11][12][13][14], (3) teorii relacji między omamami a osobą je słyszącą [15][16][17], (4) wykorzystania oprogramowania komputerowego do utworzenia awatara, w tej sytuacji awatara omamów słu-chowych [4,7]. Modele poznawcze zaburzeń psychotycznych zakładają, że oceny i przekonania odgrywają istotną rolę w tworzeniu i podtrzymywaniu objawów psychotycznych.…”

“…Wczesne prace Paula Chadwicka oraz Maxa Birchwooda [11] pokazały, że przekonania o "głosach", w szczególności dotyczące znaczenia, siły, intencji i kontroli, są kluczowe dla zrozumienia trudnych dla pacjenta konsekwencji emocjonalnych objawu. W późniejszych pracach Birchwood [13,14] zintegrował model poznawczy omamów słuchowych z podejściem relacyjnym, w któ-rym osoby słyszące głosy poprzez przekonania o głosach oceniają swoją pozycję w kategorii dominacji czy podporządkowania. Najczęściej postrzegają "głosy" jako byty silne, a siebie jako słabszych, co prowadzi do postawy podporządkowanej względem głosów.…”

“…The plan of the described therapy was developed taking into account four theoretical sources: (1) cognitive behavioural approach to psychotic symptoms [9,10], (2) cognitive theory of auditory hallucinations [11][12][13][14], (3) theory of relationships between hallucinations and the person experiencing these hallucinations [15][16][17], and (4) the use of computer software to create an avatar, in this case an avatar of auditory hallucinations [4,7]. Cognitive models of psychotic disorders assume that appraisals and beliefs play an important role in the creation and persistence of psychotic symptoms.…”

“…Ponadto awatar w trakcie terapii służył jako wyraziciel krytycznych treści, których pacjent doświadczał w kontakcie z ojcem. Słowa kluczowe: omamy słuchowe, schizofrenia, terapia poznawczo-behawioralna, techniki komputerowe, awatar.Use of an avatar in cognitive-behavioural therapy of a person who is chronically experiencing negative auditory hallucinations -case study Wykorzystanie awatara w poznawczo-behawioralnej terapii osoby przewlekle doświadczającej negatywnych omamów słuchowych -studium przypadku 277 efficacy as it resulted in significant reductions in the severity of auditory hallucinations and associated distress, as well as a reduction in scores on the scale in the revised version of the Beliefs about Voices Questionnaire -Revised Version (BAVQ-R).The plan of the described therapy was developed taking into account four theoretical sources: (1) cognitive behavioural approach to psychotic symptoms [9,10], (2) cognitive theory of auditory hallucinations [11][12][13][14], (3) theory of relationships between hallucinations and the person experiencing these hallucinations [15][16][17], and (4) the use of computer software to create an avatar, in this case an avatar of auditory hallucinations [4,7]. Cognitive models of psychotic disorders assume that appraisals and beliefs play an important role in the creation and persistence of psychotic symptoms.…”

Changing relationship with voices: new therapeutic perspectives for treating hallucinations

“…Thus, a signifi cant relationship has been found between how hearers of voices experience relationships with others in their everyday life (for example, as relatively powerless, inferior and subordinate), and how they also experience their voices powerlessly, and as subordinate to them (Birchwood, Meaden, Trower, Gilbert, & Plaistow, 2000;Birchwood et al, 2004). Beyond the personal situation itself, it may be that the voices refl ect the social atmosphere of the era in question.…”