Why do patients with psychosis listen to and believe derogatory and threatening voices? 21 reasons given by patients
Open accessAbstract
BACKGROUND: Around two-thirds of patients with auditory hallucinations experience derogatory and threatening voices (DTVs). Understandably, when these voices are believed then common consequences can be depression, anxiety and suicidal ideation. There is a need for treatment targeted at promoting distance from such voice content. The first step in this treatment development is to understand why patients listen to and believe voices that are appraised as malevolent. AIMS: To learn from patients their reasons for listening to and believing DTVs. METHOD: Theoretical sampling was used to recruit 15 participants with non-affective psychosis from NHS services who heard daily DTVs. Data were obtained by semi-structured interviews and analysed using grounded theory. RESULTS: Six higher-order categories for why patients listen and/or believe voices were theorised. These were: (i) to understand the voices (e.g. what is their motive?); (ii) to be alert to the threat (e.g. prepared for what might happen); (iii) a normal instinct to rely on sensory information; (iv) the voices can be of people they know; (v) the DTVs use strategies (e.g. repetition) to capture attention; and (vi) patients feel so worn down it is hard to resist the voice experience (e.g. too mentally defeated to dismiss comments). In total, 21 reasons were identified, with all participants endorsing multiple reasons. CONCLUSIONS: The study generated a wide range of reasons why patients listen to and believe DTVs. Awareness of these reasons can help clinicians understand the patient experience and also identify targets in psychological intervention.
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For some voice-hearers, sleep disruption increased voice frequency.
“For some voice-hearers, sleep disruption increased voice frequency”
From Towards an Integrative Account of Potential Mechanisms Mediating the Path From Sleep Dysfunction to Hallucinations (2025) · cites this paper as [1]
Some voice-hearers report no noticeable link between sleep and voices.
“However, others are clear that there is no noticeable link between sleep and voices”
From Towards an Integrative Account of Potential Mechanisms Mediating the Path From Sleep Dysfunction to Hallucinations (2025) · cites this paper as [1]
Lived experience accounts highlight the importance of cognitive processes in deciding whether to rely on what a voice is saying.
“Lived experience accounts highlight the importance of cognitive processes in deciding whether to rely on what a voice is saying.”
From Towards an Integrative Account of Potential Mechanisms Mediating the Path From Sleep Dysfunction to Hallucinations (2025) · cites this paper as [1]
Visual hallucinations can be impacted by sleep disruption.
“While voice-hearing is the most commonly investigated hallucinatory experience in qualitative accounts, there are also briefer examples of visual hallucinations being impacted by sleep disruption”
From Towards an Integrative Account of Potential Mechanisms Mediating the Path From Sleep Dysfunction to Hallucinations (2025) · cites this paper as [1]
Voice-hearers describe sleep as a prerequisite for their ability to use logic in assessing whether or not a voice is real.
“Voice-hearers describe sleep as being a prerequisite for their ability to use logic in assessing whether or not a voice is “real””
From Towards an Integrative Account of Potential Mechanisms Mediating the Path From Sleep Dysfunction to Hallucinations (2025) · cites this paper as [1]
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- Authors
- Sheaves, B., Johns, L., Griffith, L., Isham, L., Panel, T. M. H. V. L. E. A., Kabir, T., & Freeman, D.
- Affiliations
- Oxford Health NHS Foundation Trust (GB)
- Public Health England (GB)
- McPin Foundation (GB)
- Corresponding author
- Sheaves, Bryony
- Venue
- Behavioural and Cognitive Psychotherapy
- Publisher
- Cambridge University Press (CUP)
- Published
- 2020-07-29
- Volume
- 48
- Issue
- 6
- Pages
- 631-645
- ISSN
- 1352-4658 (ISSN-L)
- 1469-1833
- OpenAlex
- W3028921208
- Cited by
- 10
- References
- 14
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 1 · 2023: 2 · 2022: 1 · 2021: 1 · 2020: 1
- FWCI
- 0.92
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Behavioural and Cognitive Psychotherapy (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- National Institute for Health and Care Research (ICA-CDRF-2016-02-069, ICA-CDRF-2017-03-088, RP-2014-05-003, 2014-05-003)
- Department of Health and Social Care
- Oxford Health NHS Foundation Trust
- 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, psychosis, patient experience, threat appraisal, psychological intervention, non-affective psychosis, suicidal ideation
- MeSH terms
- Anxiety, Emotions, Hallucinations, Humans, Psychotic Disorders, Voice
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