Tailoring Cognitive Behavioral Therapy to Subtypes of Voice-Hearing

Abstract

Cognitive behavioral therapy (CBT) for voice-hearing (i.e., auditory verbal hallucinations; AVH) has, at best, small to moderate effects. One possible reason for this limited efficacy is that current CBT approaches tend to conceptualize voice-hearing as a homogenous experience in terms of the cognitive processes involved in AVH. However, the highly heterogeneous nature of voice-hearing suggests that many different cognitive processes may be involved in the etiology of AVH. These heterogeneous voice-hearing experiences do, however, appear to cluster into a set of subtypes, opening up the possibility of tailoring treatment to the subtype of AVH that a voice-hearer reports. In this paper, we (a) outline our rationale for tailoring CBT to subtypes of voice-hearing, (b) describe CBT for three putative subtypes of AVH (inner speech-based AVH, memory-based AVH, and hypervigilance AVH), and (c) discuss potential limitations and problems with such an approach. We conclude by arguing that tailoring CBT to subtypes of voice-hearing could prove to be a valuable therapeutic development, which may be especially effective when used in early intervention in psychosis services.

Non-invasive Brain Stimulation and Auditory Verbal Hallucinations: New Techniques and Future Directions

“…There is a growing awareness that AVHs are a heterogeneous phenomenon (Nayani and David, 1996 ; Jones, 2010 ; McCarthy-Jones et al, 2014 ; Woods et al, 2015 ). Given the variety in underlying cognitive and neural processes likely to be involved in qualitatively distinct AVH subtypes, therapeutic interventions need to be appropriately targeted at relevant underlying processes (Smailes et al, 2015 ). In this section, we consider the potential applicability of neurostimulation to three common subtypes of AVH: inner speech, memory and hypervigilance hallucinations.…”

“…If so, neurostimulation may be best targeted to normalize activity in bilateral auditory cortical regions (using anodal and cathodal stimulation), or to enhance neural synchrony between these regions using gamma-frequency tACS. Alternatively, it is possible that these AVHs may be more amenable to psychological therapies which aim to alter patient's appraisal of the experiences (Smailes et al, 2015 ).…”

Auditory verbal hallucinations and continuum models of psychosis: A systematic review of the healthy voice-hearer literature

“…AVHs are present in a range of mental health difficulties, including depression and anxiety, post-traumatic stress disorder, emotionally unstable personality disorder, and obsessive-compulsive disorder (Johns et al, 2014, Upthegrove et al, 2016, van Os and Reininghaus, 2016). Further, the impact and presentation of AVHs may differ within individuals in need for care, and there have been proposals to subtype AVHs in clinical research and practice (Smailes et al, 2015). …”

Auditory Verbal Hallucinations and Inner Speech : A Predictive Processing Perspective

“…As a phenomenon, it varies enormously in a number of ways: in how it presents itself phenomenologically, in terms of the context in which it occurs, and arguably in what causes it. This has lead some theorists (Jones, 2010;Wilkinson, 2014;Smailes et al, 2015) to claim that there are subtypes of AVHs, and that these amount to fundamentally different phenomena, underpinned by different mechanisms and different aetiologies. Three identified subtypes are memory-based, inner speech-based and hypervigilance hallucinations.…”