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Auditory hallucinations: a review of psychological treatments
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.
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“they may be refractory to current treatment options in around 25% of cases (Shergill et al., 1998).”
From Auditory verbal hallucinations as atypical inner speech monitoring, and the potential of neurostimulation as a treatment option (2013) · cites this paper as Shergill et al., 1998
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“Hallucinations occur in 70–80% of patients with schizophrenia and often produce distress, functional disability, and behavioral dys-control (cf. Shergill et al., 1998).”
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“Modern psychological approaches to the understanding and treatment of psychotic experiences tend to use cognitive and neuropsychological models in which such phenomena are explained in terms of attributions and/or dysfunction in regulatory processes (Shergill et al., 1998; Blakemore et al., 2000; Garety et al., 2001).”
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“Haddock, Bentall, and Slade (1996) described a systematic approach for helping patients to build a repertoire of suppression and distraction techniques, in which new techniques were introduced in each session.”
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“are resistant to medication, resulting in functional disability and a low quality of life.(2,3) With limited therapeutic options, the development of new treatment strategies(4) is needed.”
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“Moreover, in about 25% AVH are chronic and resistant to medication (Shergill et al., 1998).”
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Can fMRI-guidance improve the efficacy of rTMS treatment for auditory verbal hallucinations?
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“It is known that 25% of these patients suffer from refractory AHs (Shergill et al., 1998).”
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“However, nearly 30% patients with AVHs are nonresponsive to traditional antipsychotics (Shergill et al., 1998), and these patients do not always agree with or tolerate treatment with adequate doses of clozapine or electroconvulsive therapy to treat their medication-refractory AVHs.”
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“It is estimated that about 70% of diagnosed patients experience auditory hallucinations (Wing et al., 1974; Shergill et al., 1998).”
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“Furthermore, in approximately 30% of patients who experience this type of hallucinations, these are refractory to antipsychotic pharmacological treatment (Shergill et al., 1998).”
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“There is evidence that psychological interventions that deal with focusing attention and gaining control over mental experiences such as auditory hallucinations can reduce distress caused by symptoms (Shergill et al., 1998; Russell et al., 2008; Marsh et al., 2010).”
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“AVHs could be seen as a “marker” of a psychotic episode (Wing et al., 1974; Shergill et al., 1998; Hugdahl et al., 2009), occurring in more than 70% of patients with a schizophrenia diagnosis.”
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Self-citationBais, L., Liemburg, E. J., Vercammen, A., Bruggeman, R., Knegtering, H., & Aleman, A. (2017) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2017.04.017 · Cited by 57
“), but in 25–30% of the patients with schizophrenia AVH appear to be refractory to these interventions (Kane et al., 1988; Shergill et al., 1998).”
Aberrant resting-state connectivity in non-psychotic individuals with auditory hallucinations
Diederen, K. M. J., Neggers, S. F. W., de Weijer, A. D., van Lutterveld, R., Daalman, K., Eickhoff, S. B., Clos, M., Kahn, R. S., & Sommer, I. E. (2012) · Psychological Medicine · doi:10.1017/s0033291712002541 · Cited by 53
“Moreover, these hallucinations are refractory to pharmacological treatment in 25–30% of patients, stressing the need for development of new treatment options (Shergill et al. 1998).”
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“of about 70% [1], and are refractory to pharmacological management in about a third of such patients [2].”
BackgroundCorrelates of the Affective Impact of Auditory Hallucinations in Psychotic Disorders
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The usefulness of a self-report questionnaire measuring auditory verbal hallucinations
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“A review of the literature (27 studies) by Shergill, Murray, and McGuire (1998) found that psychological treatment of auditory hallucinations often leads to a decrease in distress and an increased sense of control, but not a reduction in the frequency of auditory hallucinations.”
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“They are usually seen in more than 60% of patients, with about one-quarter of patients experiencing an inadequate response to treatment.(12) The negative symptoms of schizophrenia are also substantially problematic.”
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“The 1-month prevalence of these hallucinations exceeds 70% (Sartorius et al., 1986), and, in 25–30% of patients, these perceptions are resistant to medication, resulting in functional disability and a low quality of life (Shergill et al., 1998; Copolov et al., 2004).”
BackgroundInfluentialAuditory hallucinations, top-down processing and language perception: a general population study
de Boer, J. N., Linszen, M. M. J., de Vries, J., Schutte, M. J. L., Begemann, M., Heringa, S. M., Bohlken, M. M., Hugdahl, K., Aleman, A., Wijnen, F. N. K., et al. (2019) · Psychological Medicine · doi:10.1017/s003329171800380x · Cited by 46
“While hallucinations are well-known as a core symptom of schizophrenia (Shergill et al., 1998), they are also associated with a wide variety of psychological disorders such as mood and anxiety disorders and personality disorders as well as in healthy individuals (Posey and Losch, 1983; Bentall, 1990; Tien, 1991; Honig…”
BackgroundMcCarthy‐Jones, S. (2012) · Schizophrenia Bulletin · doi:10.1093/schbul/sbs006 · Cited by 45
Fernández‐Caballero, A., Navarro, E., Fernández-Sotos, P., González, P., Ricarte, J. J., Latorre, J. M., & Rodríguez–Jiménez, R. (2017) · Frontiers in Neuroinformatics · doi:10.3389/fninf.2017.00064 · Cited by 45
“In addition, 25–30% of patients experience AVH that are unresponsive to antipsychotic medication (Shergill et al., 1998; Harrow et al., 2014).”
Backgroundvan de Ven, V. G., & Merckelbach, H. L. G. J. (2003) · Personality and Individual Differences · doi:10.1016/s0191-8869(02)00304-5 · Cited by 45
Rosenberg, O., Roth, Y., Kotler, M., Zangen, A., & Dannon, P. N. (2011) · Annals of General Psychiatry · doi:10.1186/1744-859x-10-3 · Cited by 44
“It has also been known to be a contributing factor in up to 25% of cases of serious suicide attempts [5].”
BackgroundCerebral blood flow alterations specific to auditory verbal hallucinations in schizophrenia.
Zhuo, C., Zhu, J., Qin, W., Qu, H., Ma, X.-L., & Yu, C.-S. (2017) · The British journal of psychiatry : the journal of mental science · doi:10.1192/bjp.bp.115.174961 · Cited by 42
Cerebellar Contributions to Persistent Auditory Verbal Hallucinations in Patients with Schizophrenia
Cierpka, M., Wolf, N. D., Kubera, K. M., Schmitgen, M. M., Vasić, N., Frasch, K., & Wolf, R. C. (2017) · The Cerebellum · doi:10.1007/s12311-017-0874-5 · Cited by 44
Effects of salicylate on serotoninergic activities in rat inferior colliculus and auditory cortex
Liu, J., Li, X., Wang, L., Dong, Y., Han, H., & Liu, G. (2003) · Hearing Research · doi:10.1016/s0378-5955(02)00708-6 · Cited by 44
Jiang, W., Cai, D.-B., Sun, C.-H., Yin, F., Goerigk, S. A., Brunoni, A. R., Zhao, X., Mayes, T. L., Zheng, W., & Xiang, Y. (2022) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2022.103100 · Cited by 42
Scheinost, D., Tokoglu, F., Hampson, M., Hoffman, R. E., & Constable, R. T. (2018) · Schizophrenia Bulletin · doi:10.1093/schbul/sby039 · Cited by 41
Ehlis, A., Barth, B., Hudak, J., Storchak, H., Weber, L. A., Kimmig, A.-C. S., Kreifelts, B., Dresler, T., & Fallgatter, A. J. (2018) · Japanese Psychological Research · doi:10.1111/jpr.12225 · Cited by 41
Hoffman, R. E. (2008) · Clinical EEG and Neuroscience · doi:10.1177/155005940803900213 · Cited by 41
Transcranial Direct Current Stimulation for Refractory Auditory Hallucinations in Schizophrenia
Andrade, C. (2013) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.13f08826 · Cited by 40
Neuroimaging of Voice Hearing in Non-Psychotic Individuals: A Mini Review
Diederen, K., van Lutterveld, R., & Sommer, I. (2012) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2012.00111 · Cited by 39
“HUMAN NEUROSCIENCE MINI REVIEW ARTICLE published: 09 May 2012 doi: 10.3389/fnhum.2012.00111 Neuroimaging of voice hearing in non-psychotic individuals: a mini review”
BackgroundInfluentialCraig, T., Rus‐Calafell, M., Ward, T., Fornells‐Ambrojo, M., McCrone, P., Emsley, R., & Garety, P. A. (2015) · Trials · doi:10.1186/s13063-015-0888-6 · Cited by 38
“tions despite adequate drug treatment [45, 46].”
Okano, K., Bauer, C. C. C., Ghosh, S., Lee, Y. J., Melero, H., Angeles, C. D. L., Nestor, P. G., del Re, E. C., Northoff, G., Whitfield, S., et al. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.112862 · Cited by 38
“Furthermore, in one third of patients experiencing AHs they are not responsive to pharmacology (Andreasen and Flaum, 1991; Copolov et al., 2004; Sartorius et al., 1986; Shergill et al., 1998).”
BackgroundGromann, P. M., Tracy, D. K., Giampietro, V., Brammer, M. J., A, L. K. M., & Shergill, S. S. (2011) · Neuropsychology · doi:10.1037/a0026603 · Cited by 37
Koops, S., Blom, J. D., Bouachmir, O., Slot, M. I. E., Neggers, B., & Sommer, I. E. (2018) · Schizophrenia Research · doi:10.1016/j.schres.2018.06.010 · Cited by 37
Repetitive Transcranial Magnetic Stimulation for Auditory Verbal Hallucinations in Schizophrenia
Hua, Q., Wang, L., He, K., Sun, J., Xu, W., Zhang, L., Tian, Y., Wang, K., & Ji, G. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.44215 · Cited by 40
Functional neuroimaging in treatment resistant schizophrenia: A systematic review
Molent, C., Olivo, D., Wolf, R. C., Balestrieri, M., & Sambataro, F. (2019) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2019.07.001 · Cited by 38
Zhang, X., Gao, J., Zhu, F., Wang, W., Fan, Y., Ma, Q., Ma, X., & Yang, J. (2018) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2018.01.002 · Cited by 34
Sanjuán, J., Toirac, I., González, J. C., Leal, C., Moltó, M. D., Nájera, C., & de Frutos, R. (2004) · European Psychiatry · doi:10.1016/j.eurpsy.2004.06.015 · Cited by 35
“Although persistent auditory hallucination is a very serious clinical problem, most of the studies are focused in psychological treatments [16,27].”
BackgroundAre hallucinations related to betrayal trauma exposure? A three-study exploration.
Gómez, J. M., Kaehler, L., & Freyd, J. (2014) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/a0037084 · Cited by 36
Insight in paranoia: The role of experiential avoidance and internalized stigma
Valiente, C., Provencio, M., Espinosa, R., Duque, A., & Everts, F. (2015) · Schizophrenia Research · doi:10.1016/j.schres.2015.03.010 · Cited by 34
“In fact, active avoiding and suppressing represent a frequently used coping strategy in psychotic patients (Shergill et al., 1998) and paranoid patients devote a great deal of effort to avoid negative implications and to maintain a positive self-presentation (Valiente et al.”
BackgroundBagati, D., Nizamie, S. H., & Prakash, R. (2009) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/00048670802653315 · Cited by 34
“Insofar as AHs respond incompletely or not at all to treatment in approximately 25% of cases [1], this neuropsychiatric syndrome remains an important public health challenge.”
BackgroundChen, C., Wang, H., Wu, S.-H., Huang, H., Zou, J.-L., Chen, J., Jiang, T., Zhou, Y., & Wang, G.-H. (2015) · Chinese Medical Journal · doi:10.4103/0366-6999.170269 · Cited by 37
“Schizophrenia is a severe psychotic disorder, which mainly shows disorder in cognition, thinking, perception, emotion, and behavior.[1,2] 70–80% schizophrenia patients suffer from auditory hallucinations (AHs),[3] which deeply affects their social functions and often results in emotional and behavioral dysfunctions.”
BackgroundZhu, J., Wang, C., Liu, F., Qin, W., Li, J., & Zhuo, C. (2016) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2016.00114 · Cited by 34
“In about Frontiers in Human Neuroscience | www.frontiersin.org 1 March 2016 | Volume 10 | Article 114 25% of these patients, AVH are chronic and resistant to medication (Shergill et al., 1998), causing an impaired quality of life (Gaite et al., 2002).”
BackgroundLi, J., Cao, X., Liu, S., Li, X., & Xu, Y. J. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113141 · Cited by 32
“In addition, some 25% to 30% of patients diagnosed with schizophrenia experience AH that are unresponsive to antipsychotic medication (Shergill et al., 1998).”
Rosenberg, O., Gersner, R., Klein, L. D., Kotler, M., Zangen, A., & Dannon, P. N. (2012) · Annals of General Psychiatry · doi:10.1186/1744-859x-11-13 · Cited by 31
“Auditory hallucinations have also been known in up to 25% of the cases to contribute to serious suicide attempts [3].”
Background
Metadata
- Authors
- Shergill, S. S., Murray, R. M., & McGuire, P. K.
- Affiliations
- King's College London (GB)
- Corresponding author
- Shergill, Sukhwinder S
- Venue
- Schizophrenia Research
- Publisher
- Elsevier BV
- Published
- 1998-08
- Volume
- 32
- Issue
- 3
- Pages
- 137-150
- ISSN
- 0920-9964 (ISSN-L)
- OpenAlex
- W1989579069
- Cited by
- 313
- References
- 67
- Citations by year
- 2026: 4 · 2025: 17 · 2024: 20 · 2023: 11 · 2022: 12 · 2021: 12 · 2020: 13 · 2019: 16 · 2018: 25 · 2017: 16 · 2016: 13 · 2015: 15 · 2014: 10 · 2013: 21 · 2012: 23
- FWCI
- 0.99
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Schizophrenia Research (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Life Sciences › Neuroscience › Cognitive Neuroscience › Hallucinations in medical conditions
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- auditory hallucinations, schizophrenia
- MeSH terms
- Auditory Perception, Behavior Therapy, Hallucinations, Humans, Schizophrenia, Antipsychotic Agents, Cognitive Behavioral Therapy
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