Skip to main content Accessibility help
×
Home

Beliefs about Voices and Schemas about Self and Others in Psychosis

  • Neil Thomas (a1), John Farhall (a2) and Frances Shawyer (a3)

Abstract

Background: In people who experience auditory verbal hallucinations, beliefs the person holds about their voices appear to be clinically important as mediators of associated distress and disability. Whilst such beliefs are thought to be influenced by broader schematic representations the person holds about themselves and other people, there has been little empirical examination of this, in particular in relation to beliefs about voice intent and the personal meaning of the voice experience. Method: Thirty-four voice hearers with a diagnosis of schizophrenia or schizoaffective disorder completed the Psychotic Symptom Rating Scales and measures of beliefs about voices (Revised Beliefs About Voices Questionnaire, Interpretation of Voices Inventory) and schemas (Brief Core Schema Scales). Results: Beliefs about voices were correlated with both negative voice content and schemas. After controlling for negative voice content, schemas were estimated to predict between 9% and 35% of variance in the six beliefs about voices that were measured. Negative-self schemas were the strongest predictors, and positive-self and negative-other schemas also showed potential relationships with beliefs about voices. Conclusions: Schemas, particularly those regarding the self, are potentially important in the formation of a range of clinically-relevant beliefs about voices.

Copyright

Corresponding author

Reprint requests to Neil Thomas, Swinburne University, Brain and Psychological Sciences Research Centre (H99), P.O. Box 218, Hawthorn, Melbourne, Victoria 3122, Australia. E-mail: neilthomas@swin.edu.au

References

Hide All
Addington, J. and Tran, L. (2009). Using the brief core schema scales with individuals at clinical high risk for psychosis. Behavioural and Cognitive Psychotherapy, 37, 227231.
Andrew, E. M., Gray, N. S. and Snowden, R. J. (2008). The relationship between trauma and beliefs about hearing voices: a study of psychiatric and non-psychiatric voice hearers. Psychological Medicine, 38, 14091417.
Barrowcliff, A. L. and Haddock, G. (2010). Factors affecting compliance and resistance to auditory hallucinations: perceptions of a clinical population. Journal of Mental Health, 19, 542552.
Beck, A. T. and Rector, N. (2003). A cognitive model of hallucinations. Cognitive Therapy and Research, 27, 1952.
Beck-Sander, A., Birchwood, M. and Chadwick, P. (1997). Acting on command hallucinations: a cognitive approach. British Journal of Clinical Psychology, 36, 139148.
Benjamin, L. S. (1989). Is chronicity a function of the relationship between the person and the auditory hallucination? Schizophrenia Bulletin, 15, 291310.
Birchwood, M. (2003). Pathways to emotional dysfunction in first episode psychosis. British Journal of Psychiatry, 182, 373375.
Birchwood, M. and Chadwick, P. (1997). The omnipotence of voices: testing the validity of a cognitive model. Psychological Medicine, 27, 13451353.
Birchwood, M., Gilbert, P., Gilbert, J., Trower, P., Meaden, A., Hay, J., et al. (2004). Interpersonal and role-related schema influence the relationship with the dominant “voice” in schizophrenia: a comparison of three models. Psychological Medicine, 34, 15711580.
Birchwood, M., Meaden, A., Trower, P., Gilbert, P. and Plaistow, J. (2000). The power and omnipotence of voices: subordination and entrapment by voices and significant others. Psychological Medicine, 30, 337344.
Chadwick, P. (2003). Two chairs, self-schemata and a person model of psychosis. Behavioural and Cognitive Psychotherapy, 31, 439449.
Chadwick, P. and Birchwood, M. (1994). The omnipotence of voices: a cognitive approach to auditory hallucinations. British Journal of Psychiatry, 164, 190201.
Chadwick, P. and Birchwood, M. (1995). The omnipotence of voices: II. the beliefs about voices questionnaire (BAVQ). British Journal of Psychiatry, 166, 773776.
Chadwick, P., Birchwood, M. and Trower, P. (1996). Cognitive Therapy for Delusions, Voices and Paranoia. Chichester: Wiley.
Chadwick, P., Lees, S. and Birchwood, M. (2000). The revised Beliefs About Voices Questionnaire (BAVQ-R). British Journal of Psychiatry, 177, 229232.
Chin, J. T., Hayward, M. and Drinnan, A. (2009). Relating to voices: exploring the relevance of this concept to people who hear voices. Psychology and Psychotherapy: Theory, Research and Practice, 82, 117.
Close, H. and Garety, P. (1998). Cognitive assessment of voices: further developments in understanding the emotional impact of voices. British Journal of Clinical Psychology, 37, 173189.
David, A. S., Buchanan, A., Reed, A. and Almeida, O. (1992). The assessment of insight in psychosis. British Journal of Psychiatry, 161, 599602.
Drake, R., Haddock, G., Tarrier, N., Bentall, R. and Lewis, S. (2007). The Psychotic Symptom Rating Scales (PSYRATS): their usefulness and properties in first episode psychosis. Schizophrenia Research, 89, 119122.
Fowler, D., Freeman, D., Smith, B., Kuipers, E., Bebbington, P., Bashforth, H., et al. (2006). The Brief Core Schema Scales (BCSS): psychometric properties and associations with paranoia and grandiosity in non-clinical and psychosis samples. Psychological Medicine, 36, 749759.
Fox, J. R. E., Gray, N. S. and Lewis, H. (2004). Factors determining compliance with command hallucinations with violent content: the role of social rank, perceived power of the voice and voice malevolence. Journal of Forensic Psychiatry and Psychology, 15, 511531.
Freeman, D. and Fowler, D. (2009). Routes to psychotic symptoms: trauma, anxiety and psychosis-like experiences. Psychiatry Research, 169, 107112.
Garety, P. A., Bebbington, P., Fowler, D., Freeman, D. and Kuipers, E. (2007). Implications for neurobiological research of cognitive model of psychosis: a theoretical paper. Psychological Medicine, 37, 13771391.
Garety, P. A., Kuipers, E., Fowler, D., Freeman, D. and Bebbington, P. E. (2001). A cognitive model of the positive symptoms of psychosis. Psychological Medicine, 31, 189195.
Haddock, G., McCarron, J., Tarrier, N. and Farragher, E. B. (1999). Scales to measure dimensions of hallucinations and delusions: the Psychotic Symptom Rating Scales (PSYRATS). Psychological Medicine, 29, 879889.
Hayward, M. (2003). Interpersonal relating and voice hearing: to what extent does relating to the voice reflect social relating? Psychology and Psychotherapy: Theory, Research and Practice, 76, 369383.
Hayward, M., Berry, K. and Ashton, A. (2011). Applying interpersonal theories to the understanding of and therapy for auditory hallucinations: a review of the literature and directions for further research. Clinical Psychology Review, 31, 13131323.
Hayward, M., Denney, J., Vaughan, S. and Fowler, D. (2008). The voice and you: development and psychometric evaluation of a measure of relationships with voices. Clinical Psychology and Psychotherapy, 15, 4552.
Hayward, M., Overton, J., Dorey, T. and Denney, J. (2009). Relating therapy for people who hear voices: a case series. Clinical Psychology and Psychotherapy, 16, 216227.
Kay, S., Opler, L. and Lindenmayer, J. P. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 261275.
Mawson, A., Cohen, K. and Berry, K. (2010). Reviewing evidence for the cognitive model of auditory hallucinations: the relationship between cognitive voice appraisals and distress during psychosis. Clinical Psychology Review, 30, 248258.
Mayhew, S. L. and Gilbert, P. (2008). Compassionate mind training for people who hear malevolent voices: a case series. Clinical Psychology and Psychotherapy, 15, 113138.
McCarthy-Jones, S. (2011). Voices from the storm: a critical review of quantitative studies of auditory verbal hallucinations and childhood sexual abuse. Clinical Psychology Review, 31, 983992.
Morrison, A. P. (1998). A cognitive analysis of auditory hallucinations: are voices to schizophrenia what bodily sensations are to panic? Behavioural and Cognitive Psychotherapy, 26, 289302.
Morrison, A. P. (2001). The interpretation of intrusions in psychosis: an integrative cognitive approach to psychotic symptoms. Behavioural and Cognitive Psychotherapy, 29, 257276.
Morrison, A. P., Frame, L. and Larkin, W. (2003). Relationships between trauma and psychosis: a review and integration. British Journal of Clinical Psychology, 42, 331353.
Morrison, A. P., Haddock, G. and Tarrier, N. (1995). Intrusive thoughts and auditory hallucinations: a cognitive approach. Behavioural and Cognitive Psychotherapy, 23, 265280.
Morrison, A. P., Northard, S., Bowe, S. E. and Wells, A. (2004). Interpretations of voices in patients with hallucinations and non-patient controls: a comparison and predictors of distress in patients. Behaviour Research and Therapy, 42, 13151323.
Morrison, A. P. and Renton, J. (2001). Cognitive therapy for auditory hallucinations: a theory-based approach. Cognitive and Behavioral Practice, 8, 147160.
Morrison, A. P., Wells, A. and Nothard, S. (2002). Cognitive and emotional predictors of predisposition to hallucinations in non-patients. British Journal of Clinical Psychology, 41, 259270.
Offen, L., Thomas, G. and Waller, G. (2003). Dissociation as a mediator of the relationship between recalled parenting and the clinical correlates of auditory hallucinations. British Journal of Clinical Psychology, 42, 231241.
Offen, L., Waller, G. and Thomas, G. (2003). Is reported childhood sexual abuse associated with the psychopathological characteristics of patients who experience auditory hallucinations? Child Abuse and Neglect, 27, 919927.
Paulik, G. (2012). The role of social schema in the experience of auditory hallucinations: a systematic review and a proposal for the inclusion of social schema in a cognitive behavioural model of voice hearing. Clinical Psychology and Psychotherapy, 19, 459472.
Peters, E., Landau, S., McCrone, P., Cooke, M., Fisher, P., Steel, C., et al. (2010). A randomized controlled trial of cognitive behaviour therapy for psychosis in a routine clinical service. Acta Psychiatrica Scandinavica, 122, 302318.
Peters, E. R., Williams, S. L., Cooke, M. A. and Kuipers, E. (2012). It's not what you hear, it's the way you think about it: appraisals as determinants of affect and behaviour in voice hearers. Psychological Medicine, 42, 15071514.
Read, J., van Os, J., Morrison, A. P. and Ross, C. A. (2005). Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica, 112, 330350.
Reiff, M., Castille, D. M., Muenzenmaier, K. and Link, B. (2012). Child abuse and the content of adult psychotic symptoms. Psychological Trauma: Theory, Research, Practice and Policy, 4, 356369.
Shawyer, F., Mackinnon, A., Farhall, J., Sims, E., Blaney, S., Yardley, P., et al. (2008). Acting on harmful command hallucinations in psychotic disorders: an integrative approach. Journal of Nervous and Mental Disease, 196, 390398.
Simms, J., McCormack, V., Anderson, R. and Mulholland, C. (2007). Correlates of self-harm behaviour in acutely ill patients with schizophrenia. Psychology and Psychotherapy: Theory, Research and Practice, 80, 3949.
Smith, B., Fowler, D. G., Freeman, D., Bebbington, P., Bashforth, H., Garety, P., et al. (2006). Emotion and psychosis: links between depression, self-esteem, negative schematic beliefs and delusions and hallucinations. Schizophrenia Research, 86, 181188.
So, S. H. W. and Wong, C. W. (2008). Experience and coping with auditory hallucinations in first-episode psychosis: relationship with stress and coping. Hong Kong Journal of Psychiatry, 18, 115121.
Sorrell, E., Hayward, M. and Meddings, S. (2010). Interpersonal processes and hearing voices: a study of the association between relating to voices and distress in clinical and non-clinical hearers. Behavioural and Cognitive Psychotherapy, 38, 127140.
Steel, C., Fowler, D. and Holmes, E. A. (2005). Trauma-related intrusions and psychosis: an information processing account. Behavioural and Cognitive Psychotherapy, 33, 139152.
Thomas, N., McLeod, H. J. and Brewin, C. R. (2009). Interpersonal complementarity in responses to auditory hallucinations in psychosis. British Journal of Clinical Psychology, 48, 411424.
Thomas, N., Morris, E. M. J., Shawyer, F. and Farhall, J. (2013). Acceptance and commitment therapy for voices. In Morris, E. M. J., Johns, L. C. and Oliver, J. E. (Eds.), Acceptance and Commitment Therapy and Mindfulness for Psychosis (pp.95111). Chichester: Wiley–Blackwell. doi:10.1002/9781118499184.ch7
Thomas, N., Rossell, S., Farhall, J., Shawer, F. and Castle, D. (2011). Cognitive behavioural therapy for auditory hallucinations: effectiveness and predictors of outcome in a specialist clinic. Behavioural and Cognitive Psychotherapy, 39, 129138.
Trower, P., Birchwood, M., Meaden, A., Byrne, S., Nelson, A. and Ross, K. (2004). Cognitive therapy for command hallucinations: randomised controlled trial. British Journal of Psychiatry, 184, 312320.
Valmaggia, L. C., van der Gaag, M., Tarrier, N., Pijnenborg, M. and Slooff, C. J. (2005). Cognitive-behavioural therapy for refractory psychotic symptoms of schizophrenia resistant to atypical antipsychotic medication. British Journal of Psychiatry, 186, 324330.
Van der Gaag, M., Hageman, M. C. and Birchwood, M. (2003). Evidence for a cognitive model of auditory hallucinations. Journal of Nervous and Mental Disease, 191, 542545.
Van der Gaag, M., Van Oosterhout, B., Daalman, K., Sommer, I. E. and Korrelboom, K. (2012). Initial evaluation of the effects of competitive memory training (COMET) on depression in schizophrenia-spectrum patients with persisting auditory verbal hallucinations: a randomized controlled trial. British Journal of Clinical Psychology, 51, 158171.
Vaughn, S. and Fowler, D. (2004). The distress experienced by voice hearers is associated with the perceived relationship between the voice hearer and the voice. British Journal of Clinical Psychology, 43, 143154.
Waters, F. A. V., Badcock, J. C., Michie, P. T. and Maybery, M. T. (2006). Auditory hallucinations in schizophrenia: intrusive thoughts and forgotten memories. Cognitive Neuropsychiatry, 11, 6583.
Wells, A. (1995). Meta-cognition and worry: a cognitive model of generalized anxiety disorder. Behavioural and Cognitive Psychotherapy, 23, 301320.
White, R. G. and Gumley, A. (2010). Intolerance of uncertainty and distress associated with the experience of psychosis. Psychology and Psychotherapy: Theory, Research and Practice, 83, 317324.

Keywords

Beliefs about Voices and Schemas about Self and Others in Psychosis

  • Neil Thomas (a1), John Farhall (a2) and Frances Shawyer (a3)

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Beliefs about Voices and Schemas about Self and Others in Psychosis

  • Neil Thomas (a1), John Farhall (a2) and Frances Shawyer (a3)
Submit a response

Comments

No Comments have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *