Elsevier

Schizophrenia Research

Volume 32, Issue 3, 17 August 1998, Pages 137-150
Schizophrenia Research

Review
Auditory hallucinations: a review of psychological treatments

https://doi.org/10.1016/S0920-9964(98)00052-8Get rights and content

Abstract

Auditory hallucinations (AH) occur frequently amongst psychiatric patients, being most common in schizophrenia. In 25–30% of cases they are refractory to traditional antipsychotic drugs. A variety of psychosocial treatments have been used, but their efficacy remains unclear. This review aims to bring together the more recent studies of psychological treatments and discuss them in the context of recent cognitive models of hallucinations and functional imaging studies. The search strategy included the following sources: MEDLINE, Embase and Psychlit. Strategies reported by patients can be categorised as: (1) distracting activities, such as listening to music; (2) behavioural tasks, such as taking exercise; (3) cognitive tasks, such as ignoring AH. Almost all the strategies produced some benefit in some patients; treatment often improved AH-associated distress, rather than frequency of AH. There are many difficulties in conducting research on AH. Treatment should be individually tailored and used as an adjunct to pharmacotherapy. Future theory-driven studies need to be based on complex aetiological models and incorporate functional imaging to elucidate the physiological changes induced by therapeutic interventions.

Section snippets

Background

Auditory hallucinations (AH) occur frequently amongst psychiatric patients, being most common in schizophrenia and often described as `voices'. A review of 16 studies (Slade and Bentall, 1988) found an average prevalence of 60% for AH in patients with a diagnosis of schizophrenia (range 25–94%). AH may also occur in normal individuals, with surveys estimating life-time prevalence rates of 10–39% in the general population (McKellar, 1968; Posey and Losch, 1983; Bentall and Slade, 1985; Tien, 1991

Search strategy

The search strategy included the following sources: The Cochrane Controlled Trials Register, MEDLINE (from 1987 to June 1997), Embase (from 1987 to May 1997) and Psychlit (from 1987 to June 1997). The reference lists of all relevant papers were checked for additional studies. Initially, randomised controlled trials and review articles were sought using the search strategy recommended by the University of York NHS Centre for reviews and dissemination. There were no double-blind randomised

Aetiological theories

First we will consider aetiological theories of AH which have a psychological therapeutic potential; for a more comprehensive review of the aetiology of AH the reader is referred to Bentall (1990). `Organic' conditions associated with AH can provide clues to the neural regions which may generate AH. Temporal lobe lesions may lead to AH (Penfield and Jasper, 1954; Perez et al., 1985). However, brain stimulation experiments have failed to provide a convincing model of `functional' AH, as the

Strategies used by patients (Table 1)

Falloon and Talbot (1981)reported on 40 patients with schizophrenia who experienced AH every day. They found that the most commonly used strategies could be grouped as (1) modification of behaviour, (2) modification of sensory input, and (3) cognitive techniques. The most common behavioural approaches were lying down or walking, attending to hobbies or reading, listening to music/television, having interpersonal contact and taking medication. Sensory modification was achieved by relaxing or

Psychological treatments

A summary of treatment studies carried out since 1988 is shown in Table 2. The more recent studies have been categorised according to their theoretical underpinnings, and the coping strategies used by patients.

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