Dr Mark Hayward has been conducting research with people who hear distressing voices for the past 20 years.
Current and upcoming research studies are listed below, click on each one to find out more.
If you would like to speak to someone regarding any one of our studies, or for information on how to take part in our research, please contact us or the appropriate person listed below.
Assertive Responding to Voices: Evaluating the psychometric properties of new measures of responding to distressing voices and other people.
Several psychological therapies are currently being developed to help people respond more assertively to the distressing voices they hear. Responding assertively means to stand-up for yourself, but in a way that is respectful of the voice or person that you are talking to. There are currently no reliable questionnaires that measure assertive responding – so we cannot be sure that a therapy is helping people to develop assertive responses.
This study aimed to develop two questionnaires – one that can measure assertive responding to voices, and another that can measure assertive responding to other people. We developed initial drafts of these questionnaires with help from researchers, clinicians and people who hear voices. For us to find out if our questionnaires were good measures, we needed people who heard voices to complete them, along with some other measures.
This research study recruited 402 participants across 14 Mental Health Trusts within the NHS in the UK. We would like to express our gratitude to everyone that contributed to the study.
The findings from the study have been published and can be found here. We have created two questionnaires – one that assesses relating to voices (‘Approve-Voices’) and one that assesses relating to other people (‘Approve-Social’) . We are pleased to make the questionnaires available for use by clinicians, researchers and people who hear voices.
The questionnaires can be downloaded here:
Building on the work of GIVE 1 and 2. Coming soon....
The range of outcomes and measures that have been used in trials of Cognitive Behavioural Therapy (CBT) for distressing voices suggests that there is a lack of consensus among professionals about what should be measured. Additionally, these outcomes have mostly been determined by professionals in the field, with little to no focus on lived experience perspectives. Consequently, the outcomes may not be representative of the changes or benefits sought by the voice hearers themselves. For that reason, the MOTIVE study seeks to explore views and perspectives of service users and practitioners about what the outcomes of CBT for distressing voices should be. This involves conducting individual interviews with service users and focus groups with practitioners.
Service users can take part if they are 18 years of age or older, have attended at least 50% of a course of CBT and are able to talk about their experience. Practitioners can take part if they have experience of delivering of CBT for distressing voices.
The findings will be used to improve clarity around the outcomes of CBT for distressing voices in both research and routine clinical practice.
This study will be recruiting until the end of January 2021
For more information, please contact Sofia Loizou: Sofia.Loizou@sussexpartnership.nhs.uk
PREFER aims to better understand how, when and where patients most want to receive therapy for voice-hearing.
PREFER is a questionnaire study in which patients who hear voices meet with a researcher to complete a set of questionnaires about their therapy preferences, mental health, and thoughts about themselves and the future. The study will help us learn how to best design and offer voice-hearing therapies to maximise their suitability for patients who hear distressing voices.
For more information please visit the Sussex Psychosis Research (SPRiG) website or see the flyer
To be eligible, patients must:
For more information please contact Hazel Frost: hazel.frost@sussexpartnership.nhs.uk or voices.clinic@sussexpartnership.nhs.uk
Many people sometimes hear a voice or voices that other people do not hear. Hearing these voices is often distressing which can make it difficult to go about daily life activities.
Psychological research suggests that distress can be reduced by changing the way the voice hearer relates to his or her voices. In particular if the hearer can change from relating in a passive and subordinate manner to relating assertively.
Building on this research, a novel approach called Relating Therapy teaches assertive responses to voices using experiential role-plays. A small pilot study in the United Kingdom with twenty-nine participants showed promising effects of Relating Therapy in reducing voice hearing related distress. The findings from this study have been published and can be found here.
The current trial is funded by the German Research Foundation and will be conducted at the Universität Hamburg in Germany under the lead of Professor Tania M. Lincoln.
In this trial, we aim to recruit seventy-five participants and to examine whether it is feasible and effective to add a module of Relating Therapy in the routine care for patients with distressing voices across different outpatient and inpatient mental health service settings in Germany.
The results of this research are expected in late 2023. If the findings are encouraging, we plan to conduct a subsequent larger multi-centre trial on Relating Therapy, which is needed in order to draw final conclusions about the benefit of Relating Therapy for patients who hear distressing voices.
Coming soon...
The GiVE study involved consultations with clinicians and people who hear voices to develop a brief, intervention based upon the ‘overcoming distressing voices’ self-help book. The team developed a workbook to guide participants through an eight-session intervention with opportunities to get involved in cognitive behavioural therapy-based self-help activities.
Data has been analysed and has found that GiVE is helpful in significantly reducing the distress caused by voices.
See a paper about the patient experience of GiVE therapy here
“The therapy was brilliant and so very helpful. It's altered the way I think and react to hearing voices."
Group mindfulness-based intervention for distressing voices: A pragmatic randomised controlled trial.
Being distressed by hearing voices (‘auditory hallucinations’) is common for people diagnosed with schizophrenia. Cognitive Behaviour Therapy offered on a one to one basis is the recommended treatment, but is rarely available in practice. One solution is to offer therapy in groups so patients can receive therapy at the same time. In 2008, a pilot study (funded by Heads On, Sussex Partnership’s charity) led by Professor Paul Chadwick and Dr Mark Hayward, assessed the effectiveness of a group therapy for voices that combined mindfulness and cognitive behavioural therapy. The results suggested the therapy was beneficial. However, pilot studies often show benefits that can’t be replicated in studies with more rigorous methodologies. Consequently, the research team needed to evaluate the therapy further and successfully applied to the Department of Health’s National Institute for Health Research to fund a randomised controlled trial. 108 patients took part in this. Half of the patients received the group therapy and their usual care, and the other half received only their usual care (the control). The results indicated that the therapy can reduce the distress caused by voices, enhance mood, improve personal control and promote recovery. However, some of the findings were not maintained over the follow-up period of six months, suggesting that further work needs to be done to strengthen the benefits.
"I took part in the study to learn new skills and to be better equipped to manage daily symptoms associated to experiencing hearing voices, for both personal and professional benefit". Jo, M4V participant.
“I got to mix with other people. It was bonding and understanding other people’s problems and the exercises were excellent. It helps me to shut the voices out when I do the exercises. It taught me I’m not alone with the problem and I can help myself.” James, M4V participant.
The Relating to Voices (R2V) study looked at the effect of relating therapy for people who experience distressing voices. Auditory hallucinations are a common and distressing experience and patients report distress reduction to be a priority. Relating therapy adopts a symptom-specific and mechanism-focused approach to the reduction of auditory hallucinations distress. Participants were randomly allocated to receive therapy or to be part of the control group.
The therapy offered 16 weeks of individual psychological therapy to help participants to relate and respond differently to their voices and other people in their social lives. The distress caused by these relationships is often maintained by the passive and/or aggressive responses of the participant. Relating therapy teaches people to relate assertively, standing-up for themselves, whilst respecting the needs of others.
Dr Mark Hayward and Dr Clara Strauss led the study and were part of the team that delivered the therapy. The study finished in 2015.
There are several psychological therapies that we know can be helpful for people who hear distressing voices - many of these therapies are currently on offer within the Voices Clinic. More research is needed on the ways in which these therapies are helpful so that they can be made more readily available in the NHS. We have ways of measuring whether these therapies help people to feel less depressed, less anxious, and feel better about themselves - but we do not have a comprehensive way of measuring the impact that voices have on people, and whether psychological therapies can improve this.
We have developed a questionnaire, with help from researchers, clinicians, and people who hear voices themselves, that we think can accurately measure the impact of voices on the person hearing them.
To request a copy of the Voice Impact Scale contact Clara Strauss: clara.strauss@nhs.net
This project is a collaboration between local researcher Dr Mark Hayward and researchers at the Voices Clinic in Swinburne, Australia. The project will evaluate if smartphones could enhance the benefit of the Level 1 coping therapy. Patients were given a smartphone at the beginning of therapy and asked to enter data about their voice-hearing experiences when prompted by the phone. The data generated by the patient can be used in the therapy sessions to provide accurate information about the patient’s current coping strategies. The success of any adapted strategies can also be accurately captured and assessed.
Case illustrations from the study detail how digital technologies such as ecological momentary assessment and intervention (EMA/I) may be used in future as clinical tools to enhance therapy, and demonstrated support for the clinical utility of the integration of smartphone EMA/I with traditional face-to-face therapy for improving coping with distressing voices. See the preliminary outcomes about a pilot randomised control trial of a brief coping-focussed intervention for hearing voices with smartphone-based ecological momentary assessment and intervention (SAVVy) here
The National Institute for Health & Care Excellence (NICE) recommends Cognitive Behavioural Therapy (CBT) as one of the best treatments for psychosis. However, only a minority of people with psychosis have the chance to receive CBT as delivery takes time and it needs to be delivered by highly trained therapists, such as clinical psychologists. We want to find out if a shorter version of CBT that is delivered by therapists with less training (such as Assistant Psychologists) is helpful for people who hear distressing voices.
We were awarded £250k by the National Institute of Health Research (NIHR) to evaluate this form of CBT by comparing it to two control groups – one group who received supportive counselling and another group who received no additional interventions.
If it proves to be cost-effective, this shorter version of CBT could be made available to more people. This study has finished recruiting and results are being analysed.
See a paper about the study here
We are investigating the psychological and brain mechanisms underlying voices hearing experiences in people with a diagnosis of Borderline Personality Disorder (BPD). We know that voices hearing is common in people who receive a BPD diagnosis, but unfortunately this is often not recognised by mental health professionals. Very little research has been done to understand what these experiences are like for people with BPD.
We hope this research will increase our understanding of voice hearing, and lead to the development of new therapies for voice hearers with a BPD diagnosis.
See a publication about the study here
Many people sometimes hear a voice or voices that other people do not hear. Some of these individuals might seek help from mental health services for voice-hearing or for other difficulties they might be facing. However, there has been little research on the views and experiences of clinical staff about voice-hearing.
The A2V Project seeks to understand more about clinicians' thoughts, feelings and approaches to working with patients who hear voices. It involves collecting clinicians' views and attitudes towards voice-hearing and the assessment of this experience in patients. The findings may be used to inform training on ways of working with this patient group in the future. We are currently analysing data and hope to share findings in 2021.
Vista is a youth mental health study looking at the social lives, relationships and activities of young people who do and do not hear voices. We are interested in better understanding what voice-hearing is like, what might make it upsetting for young people and how it might influence young people's social lives.
Many young people hear a voice or voices that other people cannot hear. Although in most cases voice-hearing will follow a transient course and can be considered part of typical development, for some young people hearing voices can be complex, persistent and be associated with numerous mental health problems later in life. Additionally, young people most at risk of long-term mental health and social disability present with social decline, in the context of non-specific symptoms. These symptoms usually include anxiety and depression and often, but not always, psychotic like experiences (e.g. hearing voices). However, we don't know much about voice-hearing in young people and how this might affect their social lives and activities.
The goal of this study is to find out more about social relationships and activities of young people who do and do not hear voices, to find out more about voice hearing in young people and better understand when voice hearing might be upsetting for young people, and to hear about the expereinces of care / support of young people distressed by hearing voices.
Research implications will focus on informing developmentally appropriate interventions for young people, including those who hear distressing voices.
This research study has now closed for recruitment. We would like to express gratitude to everyone that has contributed. We are currently analysing data and hope to share findings in 2021.
Clarke. P., Hayward. M., Jones. A-M. Increasing access to brief coping strategy enhancement for distressing voices: a service evaluation exploring a possible role for briefly-trained therapists.
Cambridge Press, Cognitive Behaviour Therapist Cambridge Core (2021)
Hayward, M., Berry. C., Cameron, B., Arnold, K., Berry, K., Bremner, S., Cavanagh, K., Fowler, D., Gage, H., Greenwood, K., Hazell, C., Jones, A-M., Robertson, S., and Strauss, C. (2020) Increasing access to CBT for psychosis patients: a feasibility, randomised controlled trial evaluating brief, targeted CBT for distressing voices delivered by assistant psychologists (GiVE2)
Bell. I., Rossell. S., Farhall. J., Hayward.M., Lim. M., Fielding-Smith. S., Thomas. N. (February 2020)
Pilot randomised controlled trial of a brief coping-focused intervention for hearing voices blended with smartphone-based ecological momentary assessment and intervention (SAVVy): Feasibility, acceptability and preliminary clinical outcomes.
Schizophrenia Research, Volume 216, Pages 479-487
Hazell, C.M., Hayward, M., Cavanagh, K., Jones, Anna-Marie. & Strauss, C. (2018). Guided self-help cognitive-behaviour Intervention for VoicEs (GiVE): Results from a pilot randomised controlled trial in a transdiagnostic sample. Schizophrenia Research, 195, 441-447.
Chadwick, P., Strauss, C., Jones, A-M., Kingdon, D., Ellet, L., Dannahy, L. & Hayward, M. (2016). Group mindfulness-based intervention for distressing voices: A pragmatic randomized controlled trial. Schizophrenia Research, 175, 168-173
Hayward. M., Jones. A-M., Strawson. WH., Quadt. L., Larsson. D.E.O., Marta. S., Davies. G., Fielding-Smith. S., Hazell C.M., Critchley. H.D. and Garfinkel. S.N. (2021)
A cross-sectional study of auditory verbal hallucinations experienced by people with a borderline personality disorder
Thomas, N., Hayward, M., Peters, E., van der Gaag, M., Bentall, R.P., Jenner, J. et al (2014). Psychological Therapies for Auditory Hallucinations (Voices): Current Status and Key Directions for Future Research. Schizophrenia Bulletin, 40 (suppl. 4), S202-S212.
Maijer, K., Hayward. M., Fernyhough, C., Calkins, M.E., Debbané, M.,, Jardri, R., et al. (2019). Hallucinations in Children and Adolescents: An Updated Review and Practical Recommendations for Clinicians. Schizophrenia Bulletin, 45 (suppl. no. 1), S5–S23.
Deamer F, Hayward M. (2018). Relating to the speaker behind the voice: What is changing? Frontiers in Psychology, 9, 11.
Hayward, M. (2018). Evidence-based psychological approaches for auditory hallucinations: Commentary on Auditory hallucinations in schizophrenia. BJPsych Advances, 24, 174-177.
Hazell, C., Greenwood, K., Fielding-Smith, S., Rammou, A., Bogen-Johnston, L., Berry, C., Jones, A-M. & Hayward, M. (2018). Understanding the barriers to accessing symptom-specific Cognitive Behavior Therapy (CBT) for distressing voices: Reflecting on and extending the lessons learnt from the CBT for psychosis literature. Frontiers, 9, 727.
Strauss, C., Thomas, N. & Hayward, M. (2015). Can we respond mindfully to distressing voices: A systematic review of evidence for engagement, acceptability, effectiveness and mechanisms of change for mindfulness-based interventions for people distressed by hearing voices. Frontiers in Psychology, 6, 1154.
Webb. R., Bart. G., James/ B. , Skan. R., Peters. E., Jones. A-M. , Garety.P., Kuipers. E., Hayward.M., and Greenwood. K., (2020). Exploring the Development, Validity, and Utility of the Short-Form Version of the CHoice of Outcome In Cbt for PsychosEs: A Patient-Reported Outcome Measure of Psychological Recovery
