Abstract
Post-traumatic mechanisms are theorised to contribute to voice-hearing in people with psychosis and a history of trauma. Phenomenological links between trauma and voices support this hypothesis, as they suggest post-traumatic processes contribute to the content of, and relationships with, voices. However, research has included small samples and lacked theory-based comprehensive assessments. In people with distressing voices (n = 73) who experienced trauma prior to voice-hearing, trauma-voice links were assessed both independently and dependently (descriptions were presented and rated separately and together, respectively) by both participants and researchers. A structured coding frame assessed four types of independent links (i.e. victimisation type, physiological-behavioural, emotional, and cognitive response themes including negative self-beliefs) and three types of dependent links: relational (similar interaction with/response to, voice and trauma); content (voice and trauma content are exactly the same); and identity (voice identity is the same as perpetrator). Independent links were prevalent in participants (51-58%) and low to moderately present in researcher ratings (8-41%) for significant themes. Identification of negative self-beliefs in trauma was associated with a significantly higher likelihood of negative self-beliefs in voices [participants odds ratio (OR) 9.8; researchers OR 4.9]. Participants and researchers also reported many dependent links (80%, 66%, respectively), most frequently relational links (75%, 64%), followed by content (60%, 25%) and identity links (51%, 22%). Trauma appears to be a strong shaping force for voice content and its psychological impact. The most common trauma-voice links involved the experience of cognitive-affective psychological threat, embodied in relational experiences. Trauma-induced mechanisms may be important intervention targets.
Highlights
Post-traumatic mechanisms are theorised to contribute to voice-hearing in people with psychosis and a history of trauma
This study aimed to examine the occurrence of two types of links assessed by the coding frame: (1) independent links: i.e. between victimisation type, physiological-behavioural response, emotional response, and cognitive response themes of traumas and voices; and (2) dependently perceived links: i.e. relational links, identity links, and content links
There was a high rate of independent phenomenological links between the most distressing interpersonal traumas and voices (51–95%; Table 2), with the highest rates for the themes of criticism/ blame, anger/anxiety/sadness, and powerless
Summary
Post-traumatic mechanisms are theorised to contribute to voice-hearing in people with psychosis and a history of trauma. In people with distressing voices (n = 73) who experienced trauma prior to voicehearing, trauma–voice links were assessed both independently and dependently (descriptions were presented and rated separately and together, respectively) by both participants and researchers. A structured coding frame assessed four types of independent links (i.e. victimisation type, physiological-behavioural, emotional, and cognitive response themes including negative self-beliefs) and three types of dependent links: relational (similar interaction with/ response to, voice and trauma); content (voice and trauma content are exactly the same); and identity (voice identity is the same as perpetrator). Independent links were prevalent in participants (51–58%) and low to moderately present in researcher ratings (8–41%) for significant themes.
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