Hearing voices in psychosis (VIP): How do they change over time?
Research type
Research Study
Full title
Hearing voices over time: A longitudinal mixed methods study of auditory verbal hallucinations in early intervention in psychosis (EIP) services
IRAS ID
220076
Contact name
Guy Dodgson
Contact email
Sponsor organisation
Northumberland Tyne & Wear NHS Foundation Trust
Duration of Study in the UK
2 years, 11 months, 31 days
Research summary
Research Summary
Hearing voices that others cannot hear (an auditory verbal hallucination; AVH) can be an unsettling and life-changing experience. AVHs are a characteristic of schizophrenia, but they can also occur in other disorders as well. Often, the contents of the hallucination – what the voices “say” – forms a huge part of the distress that they cause. For instance, many people with AVH hear voices that threaten them or encourage them to harm themselves. For some people, the voices they hear will be very simple and repetitive; for others, they might be highly complex, sounding and feeling “just like” listening to a real person. This variation can have a big personal impact, especially if the “person” they hear resembles someone from real life, such as a bully, an abuser, or a family member.
AVHs are usually only studied as part of research on schizophrenia, which includes many other symptoms (such as having strange beliefs, or problems with cognition). Because of this, detailed information about the voices people here is often either not collected, or measured only as part of overall symptom severity.
This is a problem, because the kinds of voices that people hear, and the specific content of what they say, can have big implications for the kind of care they might need and benefit from. Anecdotally, it seems like people with more complex, “person-like” voices have also been hearing voices for a longer time than people with simpler kinds of AVH. This is reflected in some of the new therapy options for AVH that are popular with people who hear voices: many Shaped by the past, creating the future 8 encourage dialogue and interaction with the voices (e.g. speaking back to an abusive voice), but this seems to be more suitable only for people with longer term care needs.
What is missing is a thorough investigation of how the experience of hearing voices changes over time. Our study aims to do this by tracking 40 adults who hear voices using Early Intervention in Psychosis (EIP) services for 24 months. People with AVH who use the EIP service will be invited to take part in an interview three times: within 6 months of their entry into services (T1), and then again at 12 months (T2) and 24 months (T3). The interview we will use is based on a 2015 survey of people who hear voices, in which they described their experiences in their own words. We have adapted the survey specifically to identify the key themes or characteristics of the voices people hear, and then explore how they might change over time. It will involve asking questions about what voices say, how they make participants feel, and whether they have person-like characteristics (such as sounding like someone known to the voice-hearer). Along with seeing how voices change over time, we can also see how their different characteristics go on to affect patients’ health and wellbeing over the same period.
A second aim of the study is to explore the links between what voices are like for a person, cognitive skills, and what’s happening in the brain. The reason we are doing this is that detailed information about what voices say is rarely gathered in studies that measure cognitive skills or brain processes, let alone gathered together over time. If we identify an important characteristic of voices that has an impact on people’s health and wellbeing, it’s important to establish whether that characteristic has a basis in changes to people’s cognitive skills, or in brain networks that have been linked to hallucinations before. To investigate this, we will invite participants to also take part in a computer-based cognitive assessment and an fMRI scanning session at each of the study time-points (T1, T2, and T3).
Summary of Results
The aim of the study was to understand more about the experience of hearing voices (or auditory hallucinations) in people using NHS services for the first time to manage psychosis. We wanted to know what these experiences are like when they start, how they might change over time, and what that might mean for the kind of support people need.
We recruited 40 people who heard voices to take part in the research, interviewing them all within their first 9 months of using Early Intervention in Psychosis (EIP) services. We found that a large minority (16/40) heard voices with strong person-like qualities that could be engaged with in conversation. This is important as some psychotherapy methods for treating voices involve creating a dialogue with a voice, but this is usually done with people who have heard voices for long time. It might be that these kinds of methods could be used earlier for some people with distressing voices.
We also managed to follow-up 23/40 people 12 months later for another interview, and 15/23 for a third interview 24 months later. Our analyses of these follow-ups is still ongoing.
REC name
North East - Newcastle & North Tyneside 1 Research Ethics Committee
REC reference
17/NE/0197
Date of REC Opinion
8 Aug 2017
REC opinion
Further Information Favourable Opinion