Negative voice-content as a full mediator of a relation between childhood adversity and distress ensuing from hearing voices

Abstract

A key predictor of whether or not an individual who hears voices (auditory verbal hallucinations; AVH) meets criteria for a psychiatric diagnosis is the level of negative content of the voices (e.g., threats, criticism, abuse). Yet the factors that contribute to negative voice-content are still not well understood. This study aimed to test the hypotheses that levels of childhood adversity would predict levels of negative voice-content, and that negative voice-content would partially mediate a relation between childhood adversity and voice-related distress. These hypotheses were tested in a clinical sample of 61 patients with formally diagnosed psychotic disorders (48 schizophrenia, 13 bipolar). We found evidence consistent with negative voice-content fully (not partially) mediating the relation between childhood adversity and voice-related distress. Although bivariate analyses found depression to be associated with both negative voice-content and voice-related distress, we found no evidence of an indirect effect of childhood adversity on either negative voice-content or voice-related distress via depression. Alternative study designs are now needed to test if our findings are replicable and causal. Should they be, it will be necessary for psychological therapies to devise ways to reduce negative voice-content itself, rather than just changing beliefs about voices. A number of techniques are discussed (Avatar Therapy, Compassion Focused Therapy, voice-dialogue) that already show promise for this.

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

“…The presence of positive hallucinations should also alert us to the possibility of other pathways. Rosen et al 44 have found that negative voice-hearing is a full mediator of a relationship between childhood adversity and distress that may arise from hearing voices. Nonclinical voice-hearers report more positive and more controllable experiences than do their clinical counterparts.…”

Working with consumers who hear voices: The experience of early career nurses in mental health services in Australia

“…; Rosen et al . ), with evidence that voices are a meaningful defensive response to adversity (Longden ), and likely to be reflective of past negative experiences (Rosen et al . ).…”

“…), with evidence that voices are a meaningful defensive response to adversity (Longden ), and likely to be reflective of past negative experiences (Rosen et al . ). People who hear voices develop a relationship with their voices: the nature of both the relationship (Beavan ; Romme & Escher ) and the content of the voices determines whether or not distress is experienced (McCarthy‐Jones et al .…”

“…The predominant biomedical view of twentieth-century psychiatry has been that voice-hearing, (termed auditory hallucinations), is a meaningless manifestation of mental illness (Moskowitz & Corstens 2008). Studies have revealed links between childhood adversity and voicehearing (Andrew et al 2008;McCarthy-Jones et al 2015;Rosen et al 2018), with evidence that voices are a meaningful defensive response to adversity (Longden 2017), and likely to be reflective of past negative experiences (Rosen et al 2018). People who hear voices develop a relationship with their voices: the nature of both the relationship (Beavan 2011;Romme & Escher 2012) and the content of the voices determines whether or not distress is experienced (McCarthy-Jones et al 2015;Rosen et al 2018).…”

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

“…The small sample size also prevented us from exploring whether diagnostic group (BPD vs. SZ) moderated the associations found between interpersonal schemata, appraisals of voices, and depression, although the PROCESS macro of Hayes [45] includes the option to examine conditional indirect effects. In addition, given the small sample size, we did not consider it appropriate to use negative voice content as a covariate in the mediation analyses, even though it has been found to influence both appraisals of voices and distress in voice hearers in our sample [29] and in previous studies [19,27,66,67]. Likewise, we did not consider the severity of positive and negative symptoms as a covariate in our analyses, even though the "psychosis as primary" model argues that interpersonal schemata and depression result from the psychotic process itself [17].…”