Our research

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:

Approve-Voices

Approve-Social questionnaires

For more information please contact Mark Hayward: mark.hayward@sussexpartnership.nhs.uk.

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 early in 2021. 

The National Institute for Health & Care Excellence (NICE) recommend Cognitive Behaviour Therapy (CBT) as one of the best treatments for psychosis. But only 10% of people with psychosis have the chance to receive CBT. CBT is scarce because it can be quite long and needs to be delivered by highly trained therapists. We want to see if a shorter version of CBT that is delivered by therapists with less training will be helpful for people who hear voices.

The purpose of this study is to find out if a shorter version of CBT delivered by briefly trained therapists can be helpful for people who hear distressing voices. We will evaluate this form of CBT by comparing it to two control groups – one group who will receive supportive counselling and another group who will receive no additional interventions.

Findings of this study would provide helpful information and inform future research into using CBT for people who experience distressing voice hearing.

For more information please contact GIVE2@sussexpartnership.nhs.uk. 

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 and 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 early in 2021. 

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 are hoping that this research will increase our understanding of voice hearing, and lead to the development of new therapies for voice hearers with a BPD diagnosis. We are currently analysing data and hope to share findings early in 2021. 

1. Guided self-help cognitive-behaviour intervention for voices (GiVE): Results from a pilot randomised controlled trial

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.

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2. Mindfulness for voices (M4V)

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.

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3. Relating to voices: relating therapy for distressing auditory hallucinations (R2V)

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.

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4. Voice impact scale (VIS)

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. 

5. Use of smartphones for coping therapy

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 publications section for  a publication on this project: Pilot randomised control trial of a brief coping-focussed intervention for hearing voices with smartphone-based ecological momentary assessment and intervention (SAVVy)

Open access papers in peer review journals 

Therapy evaluations

Commentaries and reviews