Cognitive assessment of voices: Further developments in understanding the emotional impact of voices

Objectives. This study examines cognitive behavioural assessments of auditory hallucinations ('voices') in people with psychoses. It aims to compare findings with previous work and validate the Assessment of Voices Schedule (Chadwick & Birchwood, 1994). Data were collected on appraisals of voices in relation to the self. It was hypothesized that self-appraisals may be a further factor in understanding the emotional impact of voices. Design. A replication study where data were collected from a new sample of participants and compared with a previous independent sample. Method. Voices of 30 patients with a diagnosis of schizophrenia were assessed using a semi-structured interview and questionnaires. Thought-chaining was used to assess appraisals of the voice in relation to the self. Results. Compared to the previous study, current participants were significantly less likely to believe in the omnipotence of their voices, to view their voices as omniscient and to have a positive affective response to benevolent voices. Similar numbers in this study construed their voices as malevolent, but fewer participants in this sample had benevolent voices. There were no significant differences between samples in behavioural responses to voices or in the affective responses to malevolent voices. The Assessment of Voices Schedule was found to have generally good test-retest and inter-rater reliability. Extremely negative self-appraisals were common, as were negative affective responses to the voice experience and low self-esteem. Conclusion. The implications of these findings for both cognitive behavioural models and therapy are discussed.