"Distress is probably the wrong word": exploring uncertainty and ambivalence in non-clinical voice-hearing and the psychosis continuum

BackgroundNon-clinical voice-hearers (NCVHs) have been the subject of a growing body of psychological research, a primary aim of which is the development of new therapeutic techniques to support those who struggle with voice-hearing. However, relatively little research has examined non-clinical voice-hearing experiences beyond their relationship with clinical voice-hearing.MethodsThe present study consists of a qualitative re-analysis of 17 semi-structured interviews conducted as part of an NCVH neuroimaging study which included items from the Psychotic Symptoms Rating Scale (PSYRATS) and Positive and Negative Syndrome Scale (PANSS). Results were generated using thematic analysis.ResultsAnalysis of interview responses showed that participants often experience negative voice content and negative emotion, but have frameworks which normalize a range of voice-hearing experiences. Participants also reported experiences which are not captured by standard clinical scales, as well as reporting comfort with uncertainty and ambiguity surrounding voices.DiscussionThese results indicate that much of the experience of NCVHs may be missed by clinical measures and concepts, suggesting a need to approach them in ways that go beyond typical understandings of the psychosis continuum.