CBT FOR VOICES
Maham Rehan
S2021146010
ROADMAP

Phenomenology

CBTp for Voices

Techniques

Worksheets

Others

Conclusion
VOICE HEARING PHENOMENOLOGY

The most common type of hallucination among
schizophrenia sufferers is auditory verbal
hallucinations (AVH)

Despite being a key feature of schizophrenia,
hallucinations are not unique to schizophrenia,
and have been identified in a host of other
disease states such as alcoholism, stroke,
epilepsy, syphilis, AIDS dementia, nutritional
deficiency, and more.
PHENOMENOLOGY (CONT..)

To most who experience AVH, the voices sound real
and seem to be coming from outside the individual‘s
body, although other people can't hear them.

Some voice-hearers may hear them in different places
or may hear them coming from a particular object,
such as a television.

To others, voices may talk to a person directly, or they
may talk to each other about a person, as if the voicehearer is overhearing a conversation

Voices can be pleasant but are often rude,
critical, abusive or irritating.

For many voice hearers, AVH can become a
prevalent aspect of one‘s life but may cause
varying amounts of distress depending on the
individual.
CBTP FOR VOICES

The aim is to work with distress caused by voices
by exploring beliefs about the voices

Voices themselves do not cause distress. Rather,
the presence of voices influences beliefs regarding
the voices, which in turn cause distress
(Chadwick & Birchwood, 1994).
TECHNIQUES

Normalizing

Clarify Nature of Voices

Review Beliefs and Origin

Thoughts and feelings – ABC model

Making the B-C connection

Examine the Content of Voices

Disputing automatic thoughts about voices

Experiments to test beliefs

Enhancing Coping
NORMALIZING

The therapist should convey the message that it‘s
possible to experience voices and still lead a
normal, productive, and happy life.

For Example
Sigmund Freud, Gandhi, Carl Jung
CLARIFY NATURE OF VOICES

Assess the hallucination for information regarding frequency, loudness,
content, number, and location.
Review Beliefs and Origin

Triggers of a hallucination must be identified. For instance, environmental
(where, when), internal (anxiety), cause/origin (what causes them? Where
do they come from?).

Then, the nature of the voices must be determined: Identity (who are they?
Are they helpful or harmful?), power (how powerful are they?), control
(how much control does person have over the voices?)
MAKING THE B-C CONNECTION

Facilitate a discussion of connection between
thoughts and feelings

“How would you have felt if you were thinking
differently in this situation?” What if you were
thinking…how would you have felt then?

My Thought Diary Worksheet to record
additional examples of B-C connections from
client’s recent experience.
Thought Diary
Worksheet
EXAMINE THE CONTENT OF VOICES

Can the content of the voices be shown to be
untrue (e.g. is patient always a bad person)? Do
voices tell lies?

The therapist must gather contextual evidence to
examine beliefs, fears, and meaning underlying
hallucinations.
DISPUTING AUTOMATIC THOUGHTS

Beliefs relating to the power, identity and intention of the voices.

For example, terry heard voices for over 20 years and it had
given similar commands for much of that time – so his therapist
asked, “Have you ever acted on these commands?” Terry
responded that he had never stabbed anyone or responded
violently when he heard the voice.

Therefore, terry had successfully resisted his voice’s commands
for so long and indeed they were not as powerful as he believed.
EXPERIMENTS TO TEST BELIEFS

People hearing voices are distressed by the thought “I have no
control over my voices”.

The client can be encouraged to try out some techniques for
controlling their voices (like using earplugs or reading aloud) and
then notices a change.

For Example, terry reported the voices had been frequent clear and
distressing past few days. During this session, therapist spent some
time engaged in discussion with him about one of his personal
interests – gardening. Terry had plans about some plants, replacing
them with more suitable ones. He described how enjoyable it was to
sit in the garden and watch the birds splashing in the birdbath. He
kept on talking for 5 or 10 minutes. then therapist asked him “ what
did you notice about your voices while we were talking just now?
Terry identified that he had not noticed his voices and was feeling a
little calmer – he was also visibly more relaxed.
ENHANCE COPING

Some examples of coping strategies for auditory
hallucinations include: self-monitoring (noticing
triggers), anxiety management, and distraction
(talking to someone, listening to music, going for
a walk).
WORKSHEETS

ABC

My thought diary

Experiment record
OTHERS

Medication

Transcranial Magnetic Stimulation (TMS)

Electroconvulsive therapy (ECT)
CONCLUSION