Disentangling compliance with command hallucinations: Heterogeneity of voice intents and their clinical correlates

Voice power is an important concept in daily life of voice hearers and in the support and therapy for voice hearers who seek help. Therefore, the ability to examine voice power differentials between a voice and a voice hearer is essential. The present study aimed to collect data on voice power differentials and to further validate the Voice Power Differential Scale (VPD). 105 participants aged ≥ 18 with an ICD10 F2-diagnosis that included hearing voices were included in this study. Internal consistency was good (alpha = 0.792), as well as test-retest-reliability (r = 0.855) and correlations with other constructs were generally as expected. The VPD questionnaire results correlated negatively with the Beliefs About Voices Questionnaire-Revised's (BAVQ-R) items of Benevolence and Engagement-emotion. It correlated positively with Omnipotence and Resistance-emotion, as well as with Negative Content on the Psychotic Symptoms Rating-Scale (PSYRATS). Unexpectedly, no correlations were found with overall severity and command hallucinations. The Voice Power Differential Scale is an important tool for assessing and formulating a voice hearer's experience when they seek treatment or support for their verbal auditory hallucinations. The results of this study enrich the on-going discussion about the importance of voice power for voice hearers.

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Power to the voice hearer - The German version of the voice power differential scale.

Abstract Background The long-standing view that auditory verbal hallucinations (AVH) or hearing voices is a sign of schizophrenia has been challenged by research demonstrating that they lie on a continuum ranging from normal to pathological experience related to distress and need for care. Hearing voices is more prevalent in adolescence than in later life, and hearing voices during adolescence indicates a risk for severe psychopathology, functional impairments, and suicide later in life. While there is increasing evidence for the efficacy of cognitive behavioral therapy for voices (CBTv) in adults with schizophrenia, research on psychological treatments for youth with distressing voices has been scarce. The aim of the current study is to examine the efficacy of CBTv, delivered using smartphone-based Ecological Momentary Assessment Intervention (EMI) in a transdiagnostic sample of youth. Methods This is a superiority randomized controlled trial comparing 8 weeks of CBTv-based EMI in addition to treatment as usual (TAU) versus TAU only. TAU covers both no treatment and any form of psychiatric/psychological treatment. In the EMI condition, participants will be prompted twice a day to complete an EMA survey, and receive one intervention proposal per assessment. One-hundred fifty-four youth aged 14–25 years with distressing voices will be recruited from psychiatric clinics, local private practices, internet forums, and advertisements in print and social media. Before and after the intervention phase, participants will undergo a 9-day EMA. Single-blinded assessments will be conducted at baseline (T0) and at 3-month (T1) and 6-month (T2) follow-up. The primary outcome is the distress dimension of the Auditory Hallucinations subscale of the Psychotic Symptom Rating Scales at T1. Secondary outcomes include perceived hostile intention, power, and dominance of voices, passive, aggressive, and assertive relating to voices, and negative core beliefs about the self. Discussion Adolescence provides a crucial window of opportunity for early intervention for hearing voices. However, youth are notoriously reluctant help-seekers. This study offers a low-intensity psychological intervention for youth with distressing voices beyond diagnostic boundaries that, using a mobile technology approach, may match the treatment preferences of the generation of “digital natives.” Trial registration German Clinical Trials Register DRKS00026243. Registered on 2 September 2021 

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Smartphone-assisted guided self-help cognitive behavioral therapy for young people with distressing voices (SmartVoices): study protocol for a randomized controlled trial

Uberzeugungen zum Stimmenhoren sind ein wesentlicher Faktor fur Belastung, Coping und therapeutische Interventionen bei verbalen akustischen Halluzinationen. Ziel dieser Studie war es, den international etablierten Beliefs About Voices Questionnaire-Revised (BAVQ-R) in einer deutschen Ubersetzung bei Personen mit Psychosen aus dem schizophrenen Formenkreis einzusetzen und zu validieren. 93 Personen mit Erkrankungen aus dem schizophrenen Formenkreis und aktuellen verbalen akustischen Halluzinationen fullten den BAVQ-R fur ihre dominante Stimme selbststandig aus. Weiters wurden soziodemographische und klinische Daten sowie Daten zum Schweregrad der Erkrankung (Clinical Global Impression-Schizophrenie) und symptomspezifische Dimensionen des Stimmenhorens (Psychotic Symptoms Rating Scale) erhoben. Konstruktvaliditat, Reliabilitat und Test-Retest-Reliabilitat wurden berechnet. Alle BAVQ-R Subskalen (Boswilligkeit, Wohlwollen, Widerstand, Bindung) auser der Subskala Omnipotenz zeigten zufriedenstellende interne Konsistenz. Gute Test-Retest-Reliabilitat ergab sich in den Uberzeugungssubskalen (Boswilligkeit, Wohlwollen, Omnipotenz), aber nicht in Emotionen und Verhalten im Hinblick auf Widerstand und Bindung. Die signifikanten Korrelationen zwischen den Subskalen zeigten Ergebnisse, vergleichbar mit den jenen aus der Originalstudie des BAVQ-R. Es ergaben sich keine Korrelationen mit dem Schweregrad der Erkrankung, sondern mit Ausmas und Intensitat der Belastung durch Stimmen sowie deren negativen Inhalten. Die einzuschatzenden Dimensionen bilden relevante Aspekte des subjektiven Erlebens des Stimmenhorens ab. Sowohl aus therapeutischer Sicht als auch als Forschungsbedarf stellt sich weiterhin aktuell die Frage nach der Konzeptualisierung vom Zusammenhang zwischen Kognition, Emotion und Verhalten.

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Jessica Aslan

Papers

Überzeugungen und Belastungen durch Stimmenhören: die deutsche Version des Beliefs About Voices Questionnaire – Revised (BAVQ-R)