{"id":4118,"date":"2012-08-09T10:16:17","date_gmt":"2012-08-09T15:16:17","guid":{"rendered":"http:\/\/languagelog.ldc.upenn.edu\/nll\/?p=4118"},"modified":"2012-08-14T11:54:03","modified_gmt":"2012-08-14T16:54:03","slug":"negotiating-with-hallucinations","status":"publish","type":"post","link":"https:\/\/languagelog.ldc.upenn.edu\/nll\/?p=4118","title":{"rendered":"Negotiating with hallucinations"},"content":{"rendered":"

Tanya Marie Luhrmann<\/a>, \"Beyond the Brain<\/a>\", Wilson Quarterly<\/em>, Summer 2012, writing about a new approach to treating schizophrenia:<\/p>\n

In Europe, the Hearing Voices network teaches people who hear distressing voices to negotiate with them. They are taught to treat the voices as if they were people–to talk with them, and make deals with them, as if the voices had the ability to act and decide on their own. This runs completely counter to the simple biomedical model of psychiatric illness, which presumes that voices are meaningless symptoms, ephemeral sequelae of lesions in the brain. Standard psychiatric practice has been to discount the voices, or to ignore them, on the grounds that doing so reminds patients that they are not real and that their commands should not be followed. One might think of the standard approach as calling a spade a spade. When voices are imagined as agents, however, they are imagined as having the ability to choose to stop talking. Members of the Hearing Voices movement report that this is what they do. In 2009, at a gathering in the Dutch city of Maastricht, person after person diagnosed with schizophrenia stood up to tell the story of learning to talk with the voices–and how the voices had then agreed to stop.<\/span><\/p>\n

As you might imagine, this appears to be a bit misleading, in the sense that the description of how \"person after person diagnosed with schizophrenia stood up to tell the story of learning to talk with the voices–and how the voices had then agreed to stop\" apparently does not describe a typical experience.<\/p>\n

According to Anna Ruddle, Oliver Mason, and Til Tykes (\"A review of hearing voices groups: Evidence and mechanisms of change<\/a>\", Clinical Psychology Review<\/em> 31 2011), \"Hearing Voices Groups\" are definitely a trend in treatment for people with auditory hallucinations, and not only in Europe:<\/p>\n

In recent years, health services have also begun introducing group treatment for voices to try to reduce distress. They are often viewed by service providers as a way of maximizing resources and engaging clients who might not be amenable to individual therapy, especially in inpatient settings (e.g., Davidson, Hammond, & Maguire, 2009). At\u00a0present, the content, structure, and description of these groups varies hugely between services, with some offering time-limited closed CBT [\"cognitive behavioral therapy\"] groups (e.g., \u201cGroup CBT for Auditory Hallucinations\u201d; Penn et al., 2009) and others offering open, rolling groups akin to the Hearing Voices Network (e.g., \u201cHearing Voices Support Group\u201d\/\u201cManaging Voices Group\u201d; Meddings et al., 2004). Other groups focus on relatively didactic skills-training (e.g., \u201cBehavioral Management of Auditory Hallucinations\u201d; Buccheri et al., 2004; Buffum et al., 2009) and there is now an emergence of mindfulness groups for voicehearers (e.g., Chadwick, Hughes, Russell, Russell, & Dagnan, 2009). The groups are particularly common in the UK, America, Canada, and New Zealand health services and increasingly in early intervention\u00a0services.<\/span><\/p>\n

Ruddle et al. did a qualitative and quantitative meta-analysis:<\/p>\n

An electronic search of five databases was performed (PsychINFO, Web of Science, Ovid MEDLINE, EMBASE, and CINAHL), including all papers published up to June 2010 and relevant papers from their reference lists. \u00a0[…] <\/span><\/p>\n

Any full English language paper that described or evaluated a Hearing Voices Group was included. In order to evaluate all the HVG approaches currently used in services, all types of evidence were considered (e.g., single cohort designs, wait-list control designs, RCTs). […] <\/span><\/p>\n

The search produced 25 papers which described or evaluated a Hearing Voices Group. Three further papers were included, describing RCTs for group treatment for psychosis which specifically targeted voices, giving a total of 28 papers to be reviewed. […]<\/span><\/p>\n

Their conclusion:<\/p>\n

Summary of evidence for hearing voices groups: <\/strong>To date, the HVG approaches discussed in the literature appear to fall into four categories: unstructured, open-ended support groups; skills-training groups; CBT and mindfulness. At present, there is no reliable evidence to suggest the Hearing Voices Network groups are effective so an RCT [\"randomized controlled trial\"] is needed. Large single-group studies with follow-ups suggest skills-training groups may be effective but again a controlled evaluation is needed. The one controlled evaluation of mindfulness groups failed to produce positive outcomes. CBT has the largest evidence-base to date, with at least some positive outcomes in most studies. However, the results of the RCTs were less promising than the non-randomized trials, especially comparing CBT to active treatment controls. There were often commonalities however, between the active treatment and CBT, and indeed across the four approaches reviewed here. This suggests that further investigation is warranted into the key ingredients of any HVG and what might predict or mediate change.<\/span><\/p>\n

It would be wonderful, in my opinion, if people who hear (hallucinated) voices could reliably learn to negotiate with their voices and get them to stop, or perhaps to behave in a helpful and non-distressing way. Unfortunately, this doesn't seem to be true as a general matter.<\/p>\n

The website for the Hearing Voices Network (\"for people who hear voices, see visions or have other unusual perceptions\") is here<\/a>. \u00a0Hearing Voices Network USA is here<\/a> (\"one of over 20 nationally-based networks around the world\").<\/p>\n

Update — Tanya Luhrmann has a longer article in The American Scholar, Summer 2012, \"Living With Voices: A new way to deal with disturbing voices offer hope for those with other forms of psychosis<\/a>\". It goes further than her Wilson Quarterly article in suggesting that negotiating with voices can be expected to be curative. An early paragraph:<\/p>\n

The commonsense understanding that accompanied this wisdom was that nonpharmacological treatments for schizophrenia were useless. But recently a new grassroots movement has emerged. It argues that <\/span>if patients learn to address their voices directly and appropriately, as if each voice had intention and agency, the voices will become less hostile and eventually go away. <\/strong>From the perspective of modern psychiatry, this assertion is radical, even dangerous. But it is being taken seriously by an increasing number of patients and psychiatrists. <\/span>[emphasis added]<\/em><\/p>\n

It would be terrific if this were true. But it seems to go far beyond what the Hearing Voices Network people themselves claim — and it seems straightforwardly at odds with such evidence as there is from outcomes research.<\/p>\n","protected":false},"excerpt":{"rendered":"

Tanya Marie Luhrmann, \"Beyond the Brain\", Wilson Quarterly, Summer 2012, writing about a new approach to treating schizophrenia: In Europe, the Hearing Voices network teaches people who hear distressing voices to negotiate with them. They are taught to treat the voices as if they were people–to talk with them, and make deals with them, as […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[32],"tags":[],"class_list":["post-4118","post","type-post","status-publish","format-standard","hentry","category-psychology-of-language"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/languagelog.ldc.upenn.edu\/nll\/index.php?rest_route=\/wp\/v2\/posts\/4118","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/languagelog.ldc.upenn.edu\/nll\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/languagelog.ldc.upenn.edu\/nll\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/languagelog.ldc.upenn.edu\/nll\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/languagelog.ldc.upenn.edu\/nll\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=4118"}],"version-history":[{"count":0,"href":"https:\/\/languagelog.ldc.upenn.edu\/nll\/index.php?rest_route=\/wp\/v2\/posts\/4118\/revisions"}],"wp:attachment":[{"href":"https:\/\/languagelog.ldc.upenn.edu\/nll\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=4118"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/languagelog.ldc.upenn.edu\/nll\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=4118"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/languagelog.ldc.upenn.edu\/nll\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=4118"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}