Access to cognitive behaviour therapy for those with psychosis (CBTp) remains poor. The most frequently endorsed barrier to implementation is a lack of resources. To improve access to CBTp, we developed a brief form of CBTp that specifically targets voice-related distress. The results of our pilot trial of guided self-help CBT for voices (GiVE) suggest that the therapy is both acceptable and beneficial. The present study aims to explore the subjective patient experience of accessing GiVE in the context of a trial. We interviewed nine trial participants using the Change Interview and a mixed methods approach. Most participants reported at least one positive change that they attributed to GiVE. We extracted five themes: (1) changes that I have noticed; (2) I am not alone; (3) positive therapy experiences; (4) I want more therapy; and (5) helping myself. The themes indicate that participating in the GiVE trial was generally a positive experience. The main areas in which participants experienced changes were improved self-esteem, and the ability to cope with voices. Positive changes were facilitated by embracing and enacting ‘self-help’ and having support both in and out of the therapy sessions. The findings support the use of self-help materials with those distressed by hearing voices, but that support both within and outside the clinical setting can aid engagement and outcomes. Overall, the findings support the continued investigation of GiVE.

Cognitive theories about auditory hallucinations maintain that inner speech is erroneously interpreted as coming from an external source. Few first-hand accounts of patients’ experiences have been made, so there is limited knowledge of the process through which patients distinguish their auditory verbal hallucinations (AVHs) from ordinary thoughts. 89 individuals diagnosed with schizophrenia, some experiencing acute hallucinatory symptomatology (Sz-AVHs) and some who were not (Sz-noAVHs), were assessed along with 48 individuals from the general population using the Auditory Hallucinations Assessment Questionnaire (AHAQ; Cuevas-Yust, Rodríguez Martín, Ductor Recuerda, Salas Azcona, & León Gómez, 2006). The Schz-AVHs group reported hearing ordinary thoughts at the same volume as their auditory hallucinations (p = .53) and spoken words (p = .89). In contrast, the Sz-noAVHs and general population samples reported hearing spoken words louder than their own thoughts (p = .002; p = .04). In comparison to these last two groups, the Sz-AVHs group described the sound of their thoughts as louder. These findings are consistent with the cognitive hypothesis of auditory verbal hallucinations. Confusion identifying the source of auditory hallucinations could be due, in part, to “hearing” one’s thoughts at the same volume as auditory hallucinations and spoken words.

Background: Image rescripting can be helpful in reducing the distress associated with intrusive images or memories across a range of disorders. Existing studies using imagery rescripting with people with psychosis have not included people who hear voices. Aims: This study aimed to explore the use of image rescripting with people with psychosis who have intrusive images or memories and hear voices. Method: This study used a one-off image rescripting session, using an A-B design with four participants with psychosis who were attending adult mental health community services. Results: Clinically significant reductions in distress, negative affect and reduced conviction in the beliefs associated with the imagery were reported at 1-week follow-up and maintained for three of the four participants at 1-month follow-up. Conclusions: The study offers early indications that image rescripting can be used as a treatment approach for people with psychosis. Exploring visual imagery and rescripting visual memories where appropriate may be a useful extension of cognitive behavioural therapy for psychosis (CBTp).

Background: Many people hear voices but do not access psychiatric services and their experiences are largely unknown, not least because of the difficulty in contacting such people. This study investigates the beliefs held about voices, distress experienced, and provides a topographical account of the experience of hearing voices in a sample of individuals who hear voices in a non-psychiatric population. Method: A quantitative questionnaire internet-based study with a within-subjects and between-subjects design was used. The internet was used to make contact with people who hear voices. One hundred and eighty-four participants in the general population who heard voices completed measures online assessing anxiety, depression, and beliefs about their dominant voice. Results: Participants reported a broad range of experiences associated with hearing voices, some in keeping with the previous research on clinical populations. Conclusion: The use of the internet to recruit and research non-clinical samples of people who hear voices is supported. This study provides details regarding demographic information and the experience of voice hearing from a fairly large sample of people who hear voices in a non-psychiatric population. It lends support to the idea that voice hearing occurs on a continuum, with evidence that many people hear voices in the general population and are not distressed by the experience.

The following personal reflections are in honour of Michael and all that he contributed to our lives. And, we honour Brigitte a key member of the group who died in 2006. Mem, Sue and Veronica, December 2008.