Abstract
The experience of hearing voices (‘auditory hallucinations’) can cause significant distress and disruption to quality of life for people with a psychosis diagnosis. Psychological therapy in the form of cognitive behavior therapy (CBT) for psychosis is recommended for the treatment of positive symptoms, including distressing voices, but is rarely available to patients in the United Kingdom. CBT for psychosis has recently evolved with the development of symptom-specific therapies that focus upon only one symptom of psychosis at a time. Preliminary findings from randomized controlled trials suggest that these symptom-specific therapies can be more effective for distressing voices than the use of broad CBT protocols, and have the potential to target voices trans-diagnostically. Whilst this literature is evolving, consideration must be given to the potential for a symptom-specific approach to overcome some of the barriers to delivery of evidence-based psychological therapies within clinical services. These barriers are discussed in relation to the United Kingdom mental health services, and we offer suggestions for future research to enhance our understanding of these barriers.
Highlights
Hearing the voice of someone or something that is not physically present is a common experience that can cause distress and disruption to quality of life
There is a need for formal empirical evaluation of the transdiagnostic potential of symptom-specific cognitive behavior therapy (CBT)-based approaches before this approach can be recommended without reservation. It remains unclear whether the voice hearing experiences of patients with non-psychosis diagnoses should be considered a priority for treatment, over and above the ‘core’ diagnostic features associated with their diagnosis. This can be broken down into two elements; (i) to what degree would voice hearers without a psychosis-spectrum diagnosis choose to engage with voice-focused interventions, given the alternative of access to therapies targeting other disorder-relevant etiological processes; and (ii) are distressing voices best targeted by symptom-specific CBT-based approaches, or by interventions targeting features considered more primary to the particular nonpsychosis diagnosis? It is possible, for example, that distressing voices experienced in the context of PTSD may respond better to trauma-focused interventions – a possibility that has yet to be tested empirically
A significant limitation of our paper is a consideration of CBT that specifically targets distressing voices (CBTv) only within the context of the National Health Service (NHS)
Summary
Hearing the voice of someone or something that is not physically present is a common experience that can cause distress and disruption to quality of life. If symptom-specific CBT can generate greater benefits for patients hearing distressing voices, we must consider the barriers to accessing this therapy within the NHS.
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