Voice phenomenology as a mirror of the past.
David Van den Berg, Eva Tolmeijer, Alyssa Jongeneel, Anton B P Staring, Eline Palstra, Mark Van der Gaag, Amy Hardy
Psychological medicine May 1, 2023 DOI: 10.1017/s0033291721004955 via PubMed
Summary
In people with psychosis who hear voices after experiencing trauma, trauma often shapes the content and emotional impact of those voices. Among 73 participants, independent links between trauma and voices—such as similar victimization types, emotional responses, or negative self-beliefs—were reported by 51-58% of participants and 8-41% of researchers. Dependent links, where the voice directly mirrored the trauma in content, identity, or relational dynamics, were found in 80% of participant reports and 66% of researcher ratings, with relational links being most common. Negative self-beliefs from trauma strongly predicted similar beliefs in voices. Trauma appears to be a powerful force shaping voice-hearing, suggesting that trauma-induced mechanisms may be important targets for intervention.
Study at a glance
| Characteristics | Observational cohort Peer reviewed |
|---|---|
| Sample size | 73 |
| Population | People with distressing voices who experienced trauma prior to voice-hearing |
| Topics | Philosophy of mind |
| Keywords | Voices Auditory hallucinations Psychosis Schizophrenia |
| Key finding | Trauma-related negative self-beliefs were strongly associated with similar negative self-beliefs in voices (participant odds ratio 9.8; researcher odds ratio 4.9), and most participants reported dependent trauma-voice links, especially relational links. |
Abstract
Post-traumatic mechanisms are theorised to contribute to voice-hearing in people with psychosis and a history of trauma. Phenomenological links between trauma and voices support this hypothesis, as they suggest post-traumatic processes contribute to the content of, and relationships with, voices. However, research has included small samples and lacked theory-based comprehensive assessments. In people with distressing voices (n = 73) who experienced trauma prior to voice-hearing, trauma-voice links were assessed both independently and dependently (descriptions were presented and rated separately and together, respectively) by both participants and researchers. A structured coding frame assessed four types of independent links (i.e. victimisation type, physiological-behavioural, emotional, and cognitive response themes including negative self-beliefs) and three types of dependent links: relational (similar interaction with/response to, voice and trauma); content (voice and trauma content are exactly the same); and identity (voice identity is the same as perpetrator). Independent links were prevalent in participants (51-58%) and low to moderately present in researcher ratings (8-41%) for significant themes. Identification of negative self-beliefs in trauma was associated with a significantly higher likelihood of negative self-beliefs in voices [participants odds ratio (OR) 9.8; researchers OR 4.9]. Participants and researchers also reported many dependent links (80%, 66%, respectively), most frequently relational links (75%, 64%), followed by content (60%, 25%) and identity links (51%, 22%). Trauma appears to be a strong shaping force for voice content and its psychological impact. The most common trauma-voice links involved the experience of cognitive-affective psychological threat, embodied in relational experiences. Trauma-induced mechanisms may be important intervention targets.