Voice phenomenology as a mirror of the past.
David Van den Berg, Eva Tolmeijer, Alyssa Jongeneel, Anton B P Staring, Eline Palstra, Mark Van der Gaag, Amy Hardy
Psychological Medicine May 1, 2023 DOI: 10.1017/s0033291721004955 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Observational cohort Peer reviewed |
|---|---|
| Sample size | 73 |
| Population | People with distressing voices who experienced trauma prior to voice-hearing |
| Topics | Philosophy of mind |
| Keywords | Voices Auditory hallucinations Psychosis Schizophrenia Trauma Victimisation |
| Key findings | Trauma-related negative self-beliefs were strongly associated with similar negative self-beliefs in voices (participant odds ratio 9.8; researcher odds ratio 4.9), and most participants reported dependent trauma-voice links, especially relational links. |
Abstract
Post-traumatic mechanisms are theorised to contribute to voice-hearing in people with psychosis and a history of trauma. Phenomenological links between trauma and voices support this hypothesis, as they suggest post-traumatic processes contribute to the content of, and relationships with, voices. However, research has included small samples and lacked theory-based comprehensive assessments. In people with distressing voices (n = 73) who experienced trauma prior to voice-hearing, trauma-voice links were assessed both independently and dependently (descriptions were presented and rated separately and together, respectively) by both participants and researchers. A structured coding frame assessed four types of independent links (i.e. victimisation type, physiological-behavioural, emotional, and cognitive response themes including negative self-beliefs) and three types of dependent links: relational (similar interaction with/response to, voice and trauma); content (voice and trauma content are exactly the same); and identity (voice identity is the same as perpetrator). Independent links were prevalent in participants (51-58%) and low to moderately present in researcher ratings (8-41%) for significant themes. Identification of negative self-beliefs in trauma was associated with a significantly higher likelihood of negative self-beliefs in voices [participants odds ratio (OR) 9.8; researchers OR 4.9]. Participants and researchers also reported many dependent links (80%, 66%, respectively), most frequently relational links (75%, 64%), followed by content (60%, 25%) and identity links (51%, 22%). Trauma appears to be a strong shaping force for voice content and its psychological impact. The most common trauma-voice links involved the experience of cognitive-affective psychological threat, embodied in relational experiences. Trauma-induced mechanisms may be important intervention targets.