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Abstract
Objective
Many people who hear voices (also termed auditory‐verbal hallucinations) have experienced traumatic or adverse life events. There is growing evidence that, for a number of people, these events are an important contributing factor to voice‐hearing experiences. Psychological mechanisms implicated in the trauma‐voice‐hearing relationship overlap with those involved in posttraumatic stress disorder, giving a strong rationale for the use of exposure‐based trauma‐focused therapies for distressing voices. There is currently limited clinical guidance in this area and, despite preliminary evidence of effectiveness, clinicians report reluctance to deliver these therapies. We believe that two key questions will be important in informing the delivery of exposure‐based trauma‐focused therapies for distressing voices; namely, what influences their acceptability and tolerability, and who is most likely to benefit?
Method
We present two case illustrations from an ongoing pilot trial in which people with trauma‐related voices received six sessions of imaginal exposure.
Results
The clients “Tara” and “Laura” had very different therapy outcomes and we believe their experiences provide some initial insights into processes and factors that may impact on the delivery of exposure‐based trauma‐focused therapies for voice‐hearing.
Conclusions
We highlight the potential for symptom exacerbation in early sessions and consider how this might influence acceptability, including the possibility that exposure therapy may be less tolerable when clients have persecutory appraisals of their voice‐hearing experience. We also explore the potential therapeutic importance of associations between trauma and voices, suggesting exposure therapy is particularly indicated when there is a direct link between the content of voices and the index trauma.
Funding information Barbara Dicker Brain Sciences Foundation; Swinburne University Postgraduate Research Award
Funding information Barbara Dicker Brain Sciences Foundation; Swinburne University Postgraduate Research Award
ACKNOWLEDGEMENTS
The pilot trial from which these case illustrations are taken is supported by a Swinburne University postgraduate research award (RB) and a grant from the Barbara Dicker Brain Science Foundation. We would like to express gratitude to the two clients who generously agreed to us writing about their therapy experiences. Also, to Katrina Lindblom and Imogen Bell for their input to the outcome assessments included in this manuscript.
Notes
Funding information Barbara Dicker Brain Sciences Foundation; Swinburne University Postgraduate Research Award