‘Voices Matter’ is a documentary about the growth of the Hearing Voices Movement, which was filmed over the course of three days at the 2012 World Hearing Voices Congress in Cardiff, Wales.  It was made by the Open Paradigm Project, a collective dedicated to the production of ‘creative, journalistic, promotional and educational media on behalf of those who wish to examine, learn from, and reintegrate the experience of madness or otherness in our society.’

The Hearing the Voice project directors, Charles Fernyhough and Angela Woods, were very pleased to attend the World Hearing Voices Congress.  Some thoughts on the days’ events can be found here.

The afternoon began over lunch with the Hearing Voices Network North-East Networking Event.  Jacqui Dillon, the national chair of the Hearing Voices Network in England, hosted the meeting and we were also fortunate to be joined by Rachel Waddingham, the manager of the London Hearing Voices Project. We learned that the Hearing Voices Network has made considerable progress in expanding its presence in the North-East over the last six months, with new Hearing Voices Groups developing in Sunderland, South Durham & Darlington, and Easington, among other areas.  These groups join the already established network of support groups in the region, which includes the Hearing Voices Groups in Middlesbrough, Hartlepool, Gateshead and Newcastle, as well as the ‘Unusual Experiences’ group in Durham, and the ‘Creative Minds’ groups in Harrogate and Bedale.

The second half of the afternoon was devoted to the Interactive Hearing the Voice Workshop led by our ‘Voice Club’ facilitator, Mary Robson. Charles Fernyhough and Angela Woods opened the session with a brief introduction to the project and our plans for future research.  We then heard from some of the key members of the HtV research team, including Pat Waugh, Chris Cook, Matthew Ratcliffe, and Mike White, who gave a brief account of their different areas of expertise and invited those present to break up into small groups in order to have more focussed discussions. It was fascinating to hear voice-hearers’ perspectives on the connections between voice-hearing and spirituality, literary creativity, philosophy, and the role of narrative and other creative practices in facilitating recovery for those who are distressed by their voices.  Informal groups also considered the function that errors in the monitoring of inner speech may play in the generation of voice-hearing experiences, how the latest developments in technology (e.g. smart phone and tablet apps) can help in the treatment of distressing voices, and the way in which voice-hearing is underpinned by activity in different parts of the brain (e.g. the inferior frontal gyrus and the primary auditory cortex) and the channels of communication between them.

In addition to all this, we discussed ways to reduce the stigma associated with voice-hearing, the difficulty in managing risk in Hearing Voices groups, and the way in which researchers in this area should not concentrate exclusively on ‘the voice’ that is heard, but also on the other emotional and bodily sensations that accompany the experience.  One of the key points we all agreed on was that the interpretation of voice-hearing experiences should always rest with and belong to the voice-hearer.  The Hearing the Voice team feels privileged to be able to learn from voice-hearers and group facilitators, and we look forward to continuing these conversations through meetings of the newly established HtV Reference Group, the Joint Special Interest Group in Psychosis, and other similar collaborations.

If you would like information on any of the support groups mentioned above, please email Victoria Patton or phone 0191 334 8163.

To access the articles, please click here.

Drawing on her MA in Critical Theory from Sussex University, and her MSc in Medical Humanities from King’s College London, Roz’s doctoral research will explore the possibility that narrative may assist voice-hearers who are distressed by their voices cope better with this experience.

Roz says: “Some voice-hearers see their voices as a reaction to traumatic events, or as a creative way of coping with feelings or thoughts that trouble them. If these individuals perceive their identity as fissured, then narrative may offer them a way to create a dialogue between the fractured parts, so that they relate more positively to their voices. I am interested in how voices can be made sense of, and also how this process of understanding might be traced back to the splitting that arguably occurs at the onset of voices.”

In addition to her doctoral research, Roz is hoping to set up a hearing voices group in Durham in conjunction with the Hearing Voices Network, which is currently expanding its presence in the north-east.

We warmly welcome Roz to Durham University, and look forward to working with her over the next three years.

The next meeting, featuring a presentation by Dr Mark Yeoman on ‘An Examination of the Cognitive Model of Persecutory Beliefs: What Role Do Anomolous Experiences and Arousal Play in a Search for Meaning?’, will be held on Wednesday May 29th 2013 from 5.30 – 7PM in the Joachim Room, College of St Hild and St Bede, Durham University (30 on this map).

Mark Yeoman is a recently qualified clinical psychologist who graduated from Newcastle University, and is currently working in a psychological therapies service.  His doctoral thesis examined the threat anticipation cognitive model of persecutory beliefs (Freeman, Garety, Kuipers, Fowler & Bebbington, 2002). This model proposes that persecutory threat beliefs are partly formed when people experience anomalous experiences alongside increased physiological arousal, which causes them to engage in a search for meaning process so as to make sense of their experiences. This part of the model has not previously been examined through research, and Mark’s doctoral project examined the relative contribution of anomalous experiences and arousal, as operationalised in written vignettes, on scores on a search for meaning measure. Mark’s talk will outline and discuss his research findings, and consider anomalous experiences within the context of everyday life and psychosis.

Places are limited for this event.  For more information and to reserve a place, please contact Victoria Patton.

Service users and their families and friends who attend meetings of the Joint Special Interest Group for Psychosis can receive an honorarium of £20 plus travelling expenses.  For more information and to obtain the relevant claim forms, please contact Valentina Short.

If you would like to receive information about future JSIGP meetings via email, please sign up to the JSIGP mailing list.

Conference in Celebration of 20 Years of PCCS Books
October 16th 2013, 10.00am  – 4.30pm
Clarendon Suites, Birmingham.

In order to celebrate twenty years of independent publishing, PCCS Books will be hosting a one-day conference which brings together leading experts in mental health who share the desire for ‘honest, democratic, equal and fully informed care for people in distress’.  The speakers represent the dominant themes in PCCS Books’ lists: person-centred psychology, critical psychology, and service-user perspectives.

The programme for the day includes:

Richard Bentall, Professor of Clinical Psychology, University of Liverpool
The myth that schizophrenia is a genetic disease

Mick Cooper, Professor of Counselling, University of Strathclyde
Are the facts friendly? Person-centred therapy in an era of ‘evidence-based’ practice

Jacqui Dillon, Chair of the Hearing Voices Network, England
The history and work of the Hearing Voices Network – the personal is still political

Stephen Joseph, Professor of Psychology, Health and Social Care,
University of Nottingham
The positive psychology of the person-centred approach

Joanna Moncrieff, Senior Lecturer, University College London, consultant psychiatrist
Mother’s little helper: The politics of consumerism and psychoactive drug use

Lisbeth Sommerbeck, clinical psychologist, accredited specialist in psychotherapy, Danish Psychological Association
Rebutting criticisms of applying person-centred therapy with clients diagnosed with psychosis

The conference is open to service users, carers, professionals, academics, students and anyone with an interest in critical debate on mental health care.  In order to book your place, please click here.

Fees (including lunch and refreshments):

Earlybird: £65.00 before 30th August; £75.00 31st August – 14th October; Service-users: £20.00. Please note there will be an additional £10.00 administrative charge if you want your organisation to be invoiced for your place.

Travel and Accommodation:
For information on accommodation and directions to the venue, please see the PCCS Books Conference website.

All proceeds from the conference will be donated to the Soteria Network UK.  For the full details of this event, please see the ‘Shared Practice in Non-Medicalised Health Care’ Conference Flyer.

Guy Dodgson, Consultant Clinical Psychologist (EIP), Northumberland Tyne and Wear NHS Foundation Trust, offers the following overview of his presentation to the Joint Special Interest in Psychosis Group on April 24 2013:

(i) A summary of evidence for the effectiveness of CBT for auditory verbal hallucinations

A recent review by McCarthy-Jones et al (submitted) concluded “the existing evidence from RCTs for the effectiveness of CBT for AVH is weak.  Methodological limitations of existing studies which frequently included low statistical power, failure to employ multi dimensional outcome measures of AVH and limited amounts of session time focussing on AVHs, preclude clear conclusions being reached at to the effectiveness of CBT for AVHs”.  This conclusion was reached from reviewing ten papers which reported outcomes for AVH measures.  Although some of the papers found effects at the end of treatment very few studies found any evidence at follow up of effectiveness.

A review by Robson et al had looked at single case design research on CBT for AVH.  This identified four files, three of which were too weak to be included in the review.  This was for issues related to lack of participants, measures used and number of data points collected.  Only one study was considered of sufficient robustness to be reviewed fully and this was the Fowler and Morley paper (1989).  They found replications for improvements in control over hallucinations in three of five participants.  However, other measures seem to show little effect.

A question at the end of the talk raised the issue of why the outcomes were so weak for AVH.  McCarthy-Jones et al outlined lots of methodological weaknesses including things such as low statistical power.  Other problems with research in the area is that it is difficult to secure funding for trials, certainly in comparison to drug trials where there is a powerful incentive for drug companies to invest in this area.  Therefore, there has been a shortage of good, robust, well-controlled trials.  However, a soon to be published German trial is methodologically sound with a high number of participants and this has shown a good affect for CBT with Psychosis so therefore the recent criticism for CBT for AVH will be refuted.  However, the problems are not just with the trials and with the difficulties of funding, it is likely that the intervention is currently weak and that additional effort is required to make CBT for AVH more effective.

(ii) Why is current CBT treatment for AVH weak?

Four issues were outlined. First, voice hearing often can be the “anomalous event” that triggers a delusional system.  Therefore if people are not treated quickly then voice hearing quickly becomes mixed up with delusional ideas and this becomes more difficult to treat.  Secondly, Birchwood and Trower have criticised current CBT for psychosis suggesting this is simply the extension of general CBT concepts without taking into account the specificity of psychosis..  There are no specific models which really help boost the effectiveness of the approach such as the panic model developed by Clark et al.  Thirdly, the treatments that do exist have been developed without reference to the academic literature about voice hearing.  A review by Garwood at al (in preparation) suggested that 13 out of 27 interventions had no explicit link between theory and treatment rationale and only five had a strong theoretical underpinning limited to generic CBT models.  This review did not access all treatment manuals and therefore some of these theoretical links could have been implicit in the treatment manuals but certainly there seemed to be a paucity of theory influencing treatment.  Finally, it is possible that there are different sub categories of voice hearing.   Therefore an approach which purely focuses on inner speech may not be providing the right type of intervention for other kinds of voice hearing experience.  Garwood et al (in submission) has suggested that there were indeed subcategories and one subtype –hypervigilance hallucinations – were a small but consistent pattern of people’s presentations.

(iii) CBT for AVH: A New Treatment Manual

The rest of the presentation focussed on a treatment manual which has been developed as an attempt to address the issues raised above.  This has been developed as a digital manual, accessible on an iPad to ease use and to provide video clips to help illustrate different points of psycho education.  This treatment manual focuses on two types of voice hearing: inner speech and hypervigilance.  The first part of the manual focuses on the assessment to try and identify which subtype of voice hearing the person is presenting with.  It appears common for people to have both subtypes and it may be that hypervigilance hallucinations are a trigger for the development of inner speech hallucinations.  The treatment then focuses on key areas to be addressed, starting with psychoeducation about the link between voice hearing and life’s strains. This is used to develop a formulation which highlights both the specific psychological factors behind voice hearing but also how the individual’s story fits with these models and how this has facilitated the progression of voice hearing.  In many cases this takes the form of a vicious circle; noting this helps people understand how their experiences have escalated to such an extreme.  Tailored coping strategies are then developed which also have the advantage of acting as behavioural experiments.  For example, different techniques to block the phonological loop can give control over the experience but also help demonstrate that it is related to inner speech.

In later questions an example was given of how therapy would often proceed.  The first session or two would be about developing  a history, but in particular formatting this history to try and identify the types of factors which lead to voice hearing.  These may include the nature of intrusive thoughts, factors which led to emotional and psychological strain, experiences which the individual may count as unacceptable and why this may be the case.  By the end of session three they should be pulled together into a formulation which helps describe the development of voice hearing.  This formulation is then used to guide the use of coping strategies which both confirm the formulation and give control and relief of symptoms to the individual.  These coping strategies are often reviewed in sessions four and five but also other factors which may been important in the development of voice hearing may also be addressed at this point, for example issues concerning suppressing anger, bereavement or low self esteem.

Preliminary research into the treatment manual used a single case design.  Twelve participants were identified, eight of which agreed to participate and seven of whom completed treatment.  Their summary scores were shown where some people had strong effects from the treatment according to PSYRAT scores.  However, the key to single case designs is people filling in diary measures so that there are repeated measures showing somebody’s day to day changes in symptomatology.  The only two people who had completed the daily measures were poor responders according to the PSYRATs.  However, one of these individuals, Elizabeth, actually had (according to single case design methodology) quite large effects which were attributable to the therapy.  She had also experienced unwelcome effects from the treatment and difficult and abusive past experiences  had been uncovered.  The second person who had completed the diaries, Anya, showed very few changes, particularly in her understanding the attribution of the voice hearing.  However, she did disclose some changes in control over her symptoms.  Overall, the results suggested that the treatment shows promise and the next stage is to develop into a research for patient benefit bid to try and move towards an RCT study, comparing this to other forms of CBT for voice hearing.

(iii) Further Issues

At the end of the presentation several issues were raised.  Some of the issues (why the evidence base is so weak, the more detailed description of what happened during the course of therapy) are addressed above. Other issues raised included:

(i) What is the relationship of mindfulness to this treatment? Mindfulness should provide an effective way of helping people detach themselves from the thoughts that they are experiencing if their voice hearing is related to inner speech.  This potentially could be quite a powerful way of detaching from emotion and challenging the habit forming nature of thoughts.  However, concerns were raised about creating a state where people are more likely to experience intrusive thoughts which could lead to a temporary escalation of difficulty and troublesome thoughts or voices.  The importance of understanding why an intervention is being used and linking it to a formulation was highlighted.

(ii) Would this type of intervention fit with other forms of therapy for AVH?  There are multiple approaches to treatment including medication, formulation driven treatments, coping strategy enhancement, compassion focussed therapy, Mindfulness and the hearing voices network approaches.  These interventions often focus on different levels of explanation and intervention.  For example medication reduces arousal.  The intervention discussed focuses on formulation of coping strategies.  Compassion focus therapy would maybe look at underlying factors such as low self esteem, shame or anger that may have influenced voice hearing experiences.

The last part of the discussion was taken up with focussing on how the hearing voices movement may either contradict or compliment this approach.  Concern was raised that this presentation was describing an intervention which might further polarise this field with helping people create an alternative explanation for their experience and learning to control and manage their distress.  Normalising how people are prone to get into such extreme states of life events is difficult.  The hearing voices movement tries to help people take a positive stance toward their voice and see it as a life affirming experience.  Therefore, one  approach is aiming at new ways of understanding voice hearing and eradication of the voice hearing as the ultimate goal, another approach is helping people live comfortably with the experience.  These could be seen as polarised approaches.  The key is actually what the individual is seeking to achieve when they see a clinician.  If somebody finds the experience distressing and wants it to stop then the approach will help them understand what they are experiencing and learn to control itIf somebody else has a long term relationship with their voice and is seeking to find a way to live more comfortably with them, but does not wish the experience to stop, then the hearing voices approach appears to be more valuable.  It is unfortunate that approaches can appear to be polarised.  The key for voice hearers is to be able to learn to manage and live well with the experience.  One of the big gains of the last twenty or thirty years has been to see people with psychosis as having a psychosocial explanation for their experience which is meaningful and understandable.  These approaches have all contributed to this change and if they are divided it might well slow this progress.

Jacqui Dillon, the national chair of the Hearing Voices Network in England, discusses the work of the Hearing Voices Movement at the recent conference  ‘Presence and Participation: Arguments for the Humanistic and Sustainable Work We Do’ hosted by Carina Håkansson’s Family Care Foundation in Sweden (25-27 April 2013). To listen to Jacqui’s presentation, please click here.

The full conference proceedings are available via live streaming video on MadinAmerica.com.

Hearing Voices Network North-East Networking Event
The Joachim Room, College of St Hild and St Bede
12.30 – 2 pm

Taking place over lunch, this event will be a chance to meet members of the Hearing Voices Network in the North-East and to learn about the development of new and existing Hearing Voices Groups in the region.  Jacqui Dillon, the national chair of the Hearing Voices Network in England, will be hosting the meeting and we will also be joined by Rachel Waddingham from the London Hearing Voices Project. This event is free to attend and lunch will be provided.

Interactive Hearing the Voice Workshop
The Joachim Room, College of St Hild and St Bede
2.30 – 5 pm

This session will begin with a short introduction to the Hearing the Voice project and our research plans over the next two and a half years, but the majority of the afternoon will be dedicated to conversations about voice-hearing and its relation to inner speech, spirituality, literary creativity, narratives of recovery and current work in neuroscience.  It is an opportunity for you to meet the members of our research team, ask any questions you might have, and tell us about what aspects of the experience of hearing voices are the most important to you.

Both of these events are free of charge, but as space is limited it would be great if you could RSVP for catering purposes.  Please email Victoria Patton  or telephone 0191 3348163 if you would like to attend.

On arrival at Hild-Bede, the College receptionists will show you the way to the Joachim room.  A map of the College and directions to the venue are available here.

We are happy to cover reasonable travel costs within the North-East for voice-hearers and their families to attend any aspect of the day’s events. Please retain all original receipts and we will make expenses forms available on the day.