THE OMNIPOTENCE OF VOICES - TESTING THE VALIDITY OF A COGNITIVE MODEL

Background. A preliminary report by the authors suggested that the ran ge of affect generated by voices (anger, fear, elation) was linked not to the form, content or topography of voice activity, but to the beli efs patients held about them, in particular their supposed power and a uthority. We argued that this conformed to a cognitive model; that is, voice beliefs represent an attempt to understand the experience of vo ices, and cannot be understood by reference to the form/content of voi ces alone. This study puts this cognitive model to empirical test. Met hods. Sixty-two voice hearers conforming to ICD-10 schizophrenia or sc hizoaffective diagnoses were interviewed and completed standardized me asures of voice activity; beliefs about voices and supporting evidence , coping behaviour; affect and depression. Results. Beliefs about the power and meaning of voices showed a close relationship with coping be haviour and affect (malevolent voices were associated with fear and an ger and were resisted; benevolent voices were associated with positive effect and were engaged) and accounted for the high rate of depressio n in the sample (53%). Measures df voice form and topography did not s how any link with behaviour or affect and in only one-quarter of cases did neutral observers rate voice beliefs as 'following directly' from voice content. Conclusion. The study found support for our cognitive model and therapeutic approach. Factors governing the genesis of these key beliefs remain unknown. A number of hypotheses are discussed, whi ch centre around the possibility that voice beliefs develop as part of an adaptive process to the experience of voices, and are underpinned by core beliefs about the individuals self-worth and interpersonal sch emata.