THE OMNIPOTENCE OF VOICES - A COGNITIVE APPROACH TO AUDITORY HALLUCINATIONS

We offer provisional support for a new cognitive approach to understan ding and treating drug-resistant auditory hallucinations in people wit h a diagnosis of schizophrenia. Study 1 emphasises the relevance of th e cognitive model by detailing the behavioural, cognitive and affectiv e responses to persistent voices in 26 patients, demonstrating that hi ghly disparate relationships with voices - fear, reassurance, engageme nt and resistance - reflect vital differences in beliefs about the voi ces. All patients viewed their voices as omnipotent and omniscient. Ho wever, beliefs about the voice's identity and meaning led to voices be ing construed as either 'benevolent' or 'malevolent'. Patients provide d cogent reasons (evidence) for these beliefs which were not always li nked to voice content; indeed in 31% of cases beliefs were incongruous with content, as would be anticipated by a cognitive model. Without f ail, voices believed to be malevolent provoked fear and were resisted and those perceived as benevolent were courted. However, in the case o f imperative voices, the primary influence on whether commands were ob eyed was the severity of the command. Study 2 illustrates how these co re beliefs about voices may become a new target for treatment. We desc ribe the application of an adapted version of cognitive therapy (CT) t o the treatment of four patients' drug-resistant voices. Where patient s were on medication, this was held constant while beliefs about the v oices' omnipotence, identity, and purpose were systematically disputed and tested. Large and stable reductions in conviction in these belief s were reported, and these were associated with reduced distress, incr eased adaptive behaviour, and, unexpectedly, a fall in voice activity. These changes were corroborated by the responsible psychiatrists. Col lectively, the cases attest to the promise of CT as a treatment for au ditory hallucinations.