Sussex Voices Clinic

The clinic is available to patients within some of the clinical services offered by Sussex Partnership, including:

• Eastbourne Assessment and Treatment Service
• Adur Arun and Worthing Assessment and Treatment Service
• Western Assessment and Treatment Service 
• High Weald Lewes and Havens Assessment and Treatment Service
• East Sussex CAMHS.

‘Voice hearing’ generally means hearing someone or something talking when the source of the voice does not seem to be physically present. Some people also hear other sounds, such as music.

Voices can appear to originate inside or outside the head or body. Some are fleeting and others last several minutes or longer. Some are loud and others quiet.

Voice hearing experiences can vary greatly from person to person. Some people report experiencing positive or pleasant voices, but many people experience unwanted, intrusive, distracting voices that can be very negative and critical in what they say.

It may not be possible to make voices go away for everybody who hears them but there are lots of ways to try and live well despite the continued presence of voices.

To make a referral, send the completed referral form to voices.clinic@spft.nhs.uk.

All patients who come to the clinic are offered assessment and access to brief forms of psychological therapy informed by the evidence-base and the principles of Cognitive Behavioural Therapy (CBT). 

Patients receiving therapy will continue to receive their usual care and will also be given the opportunity to find out about and take part in research studies to help improve the quality of service we offer.

It may not be possible to make voices go away for everybody who hears them but there are lots of ways to try and live well despite the continued presence of voices. This is why our therapy focuses on reducing the distress around voices, not reducing the voices themselves.  

We encourage patients in therapy to:

STOP reacting to their voices as this may not be helping

QUESTION their experience and assumptions:

• Do voices have all the power and control?
• Can voices make bad things happen?
• Do voices speak the truth?
• Do they have some control?

CHOOSE how they want to respond, after they’ve taken a step back and re-evaluated some of their assumptions about themselves and their voice hearing experiences. 
 

When referred to Sussex Voices Clinic you will be invited to an initial meeting with one of our clinic assistants. The assistant will explore your voice hearing experience and wellbeing, to find out whether the clinic is right for you. The meeting will also involve the completion of a few questionnaires about your experiences.

This meeting is a chance for you to learn more about the clinic, if it is right for you, to consider any worries or fears that you may have, and to ask any questions.

If the clinic is right for you, one of the clinic assistants will contact you to arrange a course of therapy. If the clinic is not right for you at the present time, you will continue to receive your usual care from your clinical team.

Some of our patients coming into the clinic are initially offered four sessions of individual therapy using the principles of coping strategy enhancement. This is one of the original forms of cognitive behavioural therapy and seeks to identify, adapt and systematically implement coping strategies from the patient’s existing range of strategies. You will also be offered access to the workbook that is used within the therapy.

You will meet with a therapist for one hour each week over the course of four weeks.

The therapy will help you to identify and use helpful coping strategies as consistently as possible.

Some patients coming into the clinic will be offered eight sessions of individual GiVE therapy which covers coping, re-evaluation of beliefs about self and voices, and relating assertively to the voices. 

GiVE therapy is linked to the self-help book using CBT techniques, 'Overcoming Distressing Voices' (Mark Hayward, Clara Strauss and David Kingdon) and guided by our published workbook, 'An introduction to self-help for distressing Voices' (Cassie Hazell, Mark Hayward, Clara Strauss and David Kingdon).

• Email: voices.clinic@spft.nhs.uk
• Telephone: 07825 753379
• Twitter: @sussexvoices
   

The Lived Experience Advisory Panel (LEAP) for Sussex Voices Clinic is a group of people with experience of hearing voices who support the work of the clinic. It is co-led by Lucy Walsh and Angie Culham.

The group meet two or three times a year and help the clinicians and researchers improve the service and develop research about voice-hearing.

Some of the things the group have helped out with are; improving the website, making information clearer and helping the clinic to be as friendly as possible.

If you are interested in finding out more email: voices.clinic@spft.nhs.uk

Offering support to young people who hear voices within a school setting

Sussex Voices Clinic is working with the Universities of Lancaster and Sussex and senior members of Thought-full, to run and evaluate a coping intervention for young people who are distressed by hearing voices which will be offered when and where people need it - in secondary schools, rather than waiting for an appointment within a Children and Adolescent Mental Health Service (CAMHS) setting. The ECHOES study, which opened in November 2023, offers support for young people who are distressed by hearing voices and will conduct a preliminary evaluation of a psychological intervention package for delivery through Mental Health Support Teams within secondary schools.

This brief coping intervention for young people and a workshop for the family members who support these young people are currently offered within a (CAMHS) setting, and have been found to be helpful. However, waiting lists can be long and children don't always get help as soon as they need it. When a young person is distressed by hearing voices, we want them to receive some help as soon as possible, in a school setting. We plan to work with students, parents and school staff adapt our intervention in secondary schools to be delivered by the Thought-full service in West Sussex to deliver this study, known as ECHOES. We'll talk to the participants about the therapy and this data will advise us on how helpful the intervention has been.

For more information click here 

Contact: mark.hayward@spft.nhs.uk

The aim of this research is to increase access to effective psychological interventions for psychosis patients who are distressed by hearing voices. The 'Feeling Heard' study will explore the feasibility and acceptability of offering choices within a pathway of brief and targeted interventions, delivered by a wider workforce of therapists. 

Background

Cognitive Behavioural Therapy (CBT) has been the psychological intervention recommended for the ‘positive symptoms’ of psychosis (delusions and voice hearing) for the past two decades. However, CBT has experienced two barriers to progress during this time:

1. CBT has only been able to generate small-medium amounts of benefit (relative to control groups) for patients, and adaptations have been unable to break through the barrier. A recent response to this barrier has been to target CBT at one psychotic symptom at a time (the ‘single-symptom approach’) and results have been encouraging with enhanced benefits being reported.
2. There has been limited access to CBT with only a minority of patients being offered treatment. The reasons for limited access include a lack of resources as CBT is typically delivered by highly trained therapists who are in short supply. Our response to this barrier has been to evaluate CBT for distressing voices when offered by briefly trained therapists, with preliminary findings offering encouragement. Having made progress regarding both patient benefit from CBT and increased access to CBT, we now wish to combine these approaches to maximise access and benefits. Additionally, we want to offer patients greater choice over the length and content of CBT.

Who can participate?

Adults over 18 years, with a diagnosis of psychosis and experiencing voice-hearing.

What does the study involve?

Participants will have a baseline assessment and a pathway of interventions offered over a maximum of 20 sessions with monthly assessments.

The study will be recruiting until September 2023.

This trial aims to give more people with a diagnosis of psychosis the chance to receive a helpful talking therapy. 

Background

People with a diagnosis of psychosis may experience distressing delusional beliefs and hearing voices. The National Institute for Health & Care Excellence recommend Cognitive Behaviour Therapy for psychosis (CBTp) as one of the best treatments for people with a diagnosis of psychosis. But only 26% of people with a diagnosis of psychosis have the chance to receive this talking therapy. CBTp is scarce because it can take a long time to deliver and needs to be delivered by highly trained therapists.

What does the study involve?

We have adapted CBTp in several ways to reduce its length and make it less resource intensive:

1. We have targeted CBTp at only one of the problems commonly associated with psychosis - hearing voices
2. This targeted approach has enabled us to reduce the number of sessions over which the therapy is conducted (from the recommended minimum of 16 sessions, down to 10 sessions)
3. We have structured the therapy in the form of a workbook to enable briefly trained therapists to guide people through the therapy. Our therapy is called Guided self-help CBT intervention for distressing voices (also known as the GiVE intervention). Our briefly trained therapists are called assistant psychologists. They have a degree in psychology and usually work in NHS Mental Health Services under the supervision of highly trained therapists.

Building on the GIVE 1 and 2 studies, the lessons that we learnt have helped us to design this larger study.

Who can participate?

We will include 130 people with a diagnosis of psychosis in our study:

• 65 people will be offered the GiVE intervention over 10 sessions, delivered by an assistant psychologist
• 65 people will continue to receive the usual support and treatments offered by their mental health team

Our findings will tell us if the GiVE intervention is helpful to people with a diagnosis of psychosis who hear voices, when delivered by assistant psychologists.

Timelines

The study opened on 30 April 2022 and conclude on 30 October 2024.

The recruitment of participants is planned for the 12-month period from October 2022 to September 2023

For more information: email: mark.hayward@spft.nhs.uk

• Give3 Plain language summary
• Guided self-help CBT for voices

Study protocol

See the protocol for GiVE 3 here

Background

Anorexia Nervosa (AN) can have a serious and severe impact on individuals and those around them. Recommended psychological interventions are typically not found to be helpful by people with AN who often have difficulties for a long time, and have regular periods of relapse. Due to this, there have been calls for new therapeutic approaches. Research suggests that voice-hearing experiences are common in those with AN and that over time, a relationship is formed with what is often called the “Anorexic Voice” (AV) or the “Eating Disorder Voice” (EDV). Individuals’ beliefs about and ways of relating to their AV may be a factor in the development and maintenance of AN. Our research aims to explore the potential for a targeted psychological therapy called Relating Therapy to reduce the distress associated with voice-hearing experiences within the context of AN. Relating Therapy targets the negative relating that can maintain voice-related distress and teaches assertiveness as an alternative response.

What are the benefits/risks of taking part?

Although the therapy being evaluated within this study has been found to be acceptable and effective for people with different mental health problems, it has only been delivered to a small number of people with AN before. For this reason, we do not know whether it will be helpful for people with AN. Participants will help us to learn if Relating Therapy will be helpful to people with AN, and this will help mental health services when they are planning what therapies they offer. Participants may find that talking about the AV can be helpful, though it can also sometimes feel difficult or distressing. The therapists will be trained in the treatment of AN and distressing AVs and will help participants cope with any temporary increases in distress, should this occur.

What will taking part involve?

All participants will be offered Relating Therapy over a period of 24 weeks. Participants will be asked to complete different questionnaires before, during and after receiving the intervention to help us better understand the impact of receiving this therapy.

Who can take part?

Adult patients with AN who have reported distressing experiences with an AV.

This study is led by Sussex Voices Clinic, part of Sussex Partnership NHS Foundation Trust.

It is funded by Canterbury Christ Church University (UK) and Economic and Social Research Council (ESRC) (UK). The study will run from December 2022 to April 2024.

Contact:

Professor Mark Hayward:

E: m.hayward@spft.nhs.uk 

Background

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.  

For more information: email matthias.pillny@uni-hamburg.de
Download:  Study protocol

Auditory hallucinations in the form of spoken language (i.e. hearing voices) often first occur in adolescence or young adulthood. Hearing voices can be associated with emotional distress and impairment in everyday life.

Background

To date, there are hardly any evaluated therapy programmes for young people who hear voices. Our study aims to investigate whether smartphone-assisted psychological therapy for adolescents and young adults helps to reduce voice-related distress.

An 8-week, smartphone-based Ecological Momentary Intervention (EMI), in addition to treatment as usual, will be compared to treatment as usual in this randomised controlled trial. 

The study is aimed at young people between the ages of 14 and 25 with distressing voices, regardless of their mental disorder or whether or not they meet the criteria for a psychiatric diagnosis.

Study participants are randomly assigned to one of two conditions: In the therapy condition, study participants receive a text message twice a day for 8 weeks with a suggested exercise to learn a helpful way to manage their voices. In the control condition, the study participants do not receive any study-specific intervention. The effectiveness of the intervention will be assessed by means of clinical interviews and (online) questionnaires immediately before and after the intervention phase and again at a later time (6 months after the start of the study). The study participants will have the chance to receive a highly specialised psychological therapy for hearing voices. We assume that this therapy can help young people who hear voices to be less troubled and to cope better in their lives again. In order to find out whether this is actually the case, we are conducting this study. In doing so, we intend to contribute to early intervention of mental disorders.

Who can participate?

154 adolescents and young adults aged between 14 and 25 years with distressing voices will be recruited from psychiatric hospitals and the general population in Switzerland. 

For more information: email mark.hayward@sfpt.nhs.uk

• Smartphone-assisted guided self-help cognitive behavioural therapy for young people with distressing voices (SmartVoices): study protocol for a randomized controlled trial

Our staff flyers detail who can be referred, what the referral process is, and what happens after a referral. Our patient flyers detail, if you are a patient, how you can be referred to the Voices Clinic and what happens next. 

• Sussex Voices Clinic flyer
• East Sussex CAMHS flyer
• Sussex Voices Clinic poster

Choices app

Choices for Voices is a tool to support the management of distressing voice hearing experiences. Developed by Sussex Partnership NHS Foundation Trust, Choices for Voices aims to support the continued use of strategies that have been learnt within Sussex Voices Clinic. Regular use of these strategies can help people to live well despite the continued presence of voice hearing experiences.

The app supports learning when patients leave the clinic and can help with coping strategies, assertive responding and core beliefs and voices beliefs. It can also be adapted to reflect the specific learning 

Choices app usage guide

Overcoming Distressing Voices

A practical self-help guide, using clinically proven techniques, for managing distressing voice hearing experiences. It was written by Mark Hayward and colleagues, and offers strategies similar to those used in the Voices Clinic therapy.

Overcoming Distressing Voices book

Coping therapy workbook

Using coping strategies is one way of helping people manage their voices. Coping strategies can help make voices less distressing and help people feel more in control and be able to get on with our lives. People may already use coping strategies without being aware of it.

Coping strategy enhancement is focused on exploring people's coping strategies for voices hearing. The aim is to help patients identify helpful coping strategies and use these as consistently and effectively as possible.  

Please download a copy of the coping therapy workbook, or read the research paper.

Hearing Voices Network

The Hearing Voices Network (HVN) aims to:

• "Raise awareness of voice hearing, visions, tactile sensations and other sensory experiences"
• "Give men, women and children who have these experiences an opportunity to talk freely about this together"
• "Support anyone with these experiences seeking to understand, learn and grow from them in their own way"

Visit the Hearing Voices website to explore their information about voices and resources, including free downloads.

The HVN is made up of 180 groups across the UK. They also run worldwide.

These groups allow people with lived experience of hearing voices to support each other. They are a safe space for people to share experiences and to support one another. The groups are based on self-help and peer support, and do not involve therapy or treatment.

In Sussex HVN run groups in Brighton, Bognor and Worthing.

Find a group near you. 

Recovery College

The Recovery College offers short courses for people who experience mental distress, their families and carers and clinicians.

All the courses are run by someone with lived experience and a clinician.

Recovery College courses have included: ‘Increasing your self-esteem and being more confident’ ‘Understanding Psychosis’, amongst many others.

Other clinics

We work closely with the Voices Clinics in Perth and Melbourne. 

Webinar presentation: 'Don’t react! Choose How to Relate to Distressing Voices, with Mark Hayward'

There has recently been a shift from conceptualizing a voice as a sensory stimulus that the hearer holds beliefs about, to a voice as a person-like stimulus which the hearer has a relationship with.

Understanding voice hearing experiences within relational frameworks has resulted in the development of psychological therapies that focus upon the experience of relating to and with distressing voices.

This presentation explores lessons learnt from the development, experience and evaluation of one of these therapies - Relating Therapy. These lessons are located within the broader context of other relationally-based therapies that seek to support recovery through the use of digital enhancement (Avatar Therapy) and dynamic interaction with voices (Talking with Voices). 
 

Professor Mark Hayward answers questions posed to him about voice-hearing and treating auditory hallucinations for Psychwire ASK. See the answers to these and other questions. 

Two research participants who hear voices have co-written a chapter in a new book focusing on voice-hearing along with Professor Mark Hayward, Director of the Sussex Voices Clinic.

The Practical Handbook of Hearing Voices: Therapeutic and Creative Approaches includes chapters written by Professor Mark Hayward, Director of Research and Development at Sussex Partnership NHS Foundation Trust, who writes from a clinical perspective and Angie Culham and Sheila Evenden, participants in therapy for voice-hearing. 

See an article about the Voices Clinic in Mental Health Today.

A film made by Mark Norman for BBC South East with Professor Mark Hayward.

Harvey, E., Mutanda, D., Jones, A.M. & Hayward, M. (2022)

How should psychological interventions for distressing voices be delivered: a comparison of outcomes for patients who received interventions remotely or face-to-face within routine clinical practice?  Psychosis, DOI: 10.1080/17522439.2022.2128860

Hayward M, Frost H, Naito A, Jones A-M. (2022).

Coping strategy enhancement for the treatment of distressing voices in young people: A service evaluation within routine clinical practice. Clinical Child Psychology and Psychiatry, 27(4):1209-1220. DOI:10.1177/13591045211061803

Hall, B, Hayward, M. & Terry, R. (2022)  

A grounded theory study exploring change processes following cognitive behavioural therapy for distressing voices Psychosis, DOI: 10.1080/17522439.2022.2044896

Morrice, F., Jones, A.-M., Burgio, V., Strauss, C., & Hayward, M. (2022).

Brief coping strategy enhancement for the treatment of distressing voices in the context of borderline personality disorder: A comparison with outcomes in the context of psychosis. Clinical Psychology & Psychotherapy, 29, 567-578. https://doi.org/10.1002/cpp.2647

Clarke, P., Jones, A-M. & Hayward, M. (2021).

Increasing access to brief Coping Strategy Enhancement for distressing voices: a service valuation exploring a possible role for briefly-trained therapists. The Cognitive Behaviour Therapist, Volume 14, e16. https://doi.org/10.1017/S1754470X21000143

Webb, R., Bartl, G., James, B., Skan, R., Peters, E., Jones, A-M, Garety, P., Kuipers, E., Hayward, M. & Greenwood, K. (2020).

Exploring the development, validity and utility of the Short Form version of the CHoice of Outcome In Cbt for psychosEs (CHOICE-SF): A patient reported outcome measure of psychological recovery. Schizophrenia Bulletin, 47, 653-661. https://doi.org/10.1093/schbul/sbaa173

Jones, A., Strauss, C., & Hayward, M. (2021).

A service evaluation of a group mindfulness-based intervention for distressing voices: How do findings from a randomized controlled trial compare with routine clinical practice? Behavioural and Cognitive Psychotherapy, 49(1), 76-90. https://doi.org/10.1017/S1352465820000624  

McHale, C., Hayward, M. & Jones, F.W. (2018).

Building a grounded theory of engagement in mindfulness-based group therapy for distressing voices. Qualitative Health Research, 28, 2169-2182. https://doi.org/10.1177/1049732318789897

Paulik, G., Jones, A-M. & Hayward, M. (2018).

Brief Coping Strategy Enhancement for distressing voices: Predictors of engagement and outcome in routine clinical practice. Clinical Psychology & Psychotherapy, 25, 634–640. https://doi.org/10.1002/cpp.2299

Hayward, M., Edgecumbe, R., Jones, A-M, Berry. C. & Strauss, C. (2018).

Brief Coping Strategy Enhancement for distressing voices: an evaluation in routine clinical practice. Behavioural & Cognitive Psychotherapy, 46, 226–237  https://doi.org/10.1017/S1352465817000388
 

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.

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.

See the published results from GIVE2 here

For more information: email mark.hayward@spft.nhs.uk

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.

• Open access paper: Group mindfulness-based intervention for distressing voices: A pragmatic randomised controlled trial

Background

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.

Who can participate?

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. 

This study finished recruiting in January 2022.

What did we find?

Exploring service users’ and practitioners’ priorities regarding outcomes of cognitive behavioural therapy for distressing voices: a thematic analysis Loizou. S, Fowler. D, and Hayward. M (2023)

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 is now closed.

What is the study about?  

Patient preferences for psychological therapies are helpful in informing treatment commissioning and provision, especially in the context of complex and variable experiences like voice-hearing. There is, however, very limited evidence as to the psychological therapy preferences of transdiagnostic voice-hearers. Before the study, we knew that lots of different psychological (talking) therapies exist for people who hear voices. However, there wasn't really any evidence about what patients themselves particularly wanted.

Therefore, the PREFER study aimed to explore patient preferences for psychological therapies for the experience of hearing distressing voices. We asked patients, who hear voices to tell us about their therapy preferences, such as when and where should therapy take place, and also, what should therapy involve and what it should aim to improve.

Over 330 people part between 2020 and 2022. Participants completed a series of questionnaires, involving a psychological therapy preference survey. Participants ranked their preferences across categories of practical, technical and relational therapy elements. We are grateful to everyone who took part or supported the study.

Who is running the study?

This study is led by Dr Clio Berry, Brighton and Sussex Medical School, with Dr Mark Hayward, Sussex Partnership NHS Foundation Trust, and Professor David Fowler, University of Sussex. The study is sponsored by the University of Sussex and is funded by an Economic and Social Research Council (ESRC) Impact Acceleration Award.

Why is the study being run?

The findings will be used to inform researchers and clinicians to help them develop and offer the types of therapies that patients really want.

Study findings

Overall, participants expressed a preference for individual, face-to-face intervention of at least nine sessions, with a highly experienced therapist (ideally with personal experience of voice hearing), collaborative, evidence-based and a core focus on enhancing coping strategies for voice-hearing experiences.

The findings will be used locally in Sussex to inform the practice of the Sussex Voices Clinic.

The results are published in a paper here.

Here is an easy read findings summary.

Contact

Email: AskAboutResearch@spft.nhs.uk

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.

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).

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 and another example 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 sought to understand more about clinicians' thoughts, feelings and approaches to working with patients who hear voices. It involved 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. Findings have thrown up a training need for clinicians to have confidence in working with patients who hear voices - If any organisations/services are interested in training to enhance the confidence of their clinicians, they can contact the Sussex Voices Clinic and request a training course.

• Read a summary of the research findings
• Read a report on the research findings

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 wanted a 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, led by Dr Aikaterini Rammou, was 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 experiences 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, whether by taking part or by supporting young people to take part.

Study findings

We're pleased to share the findings from this study:

68 young people, between the ages of 14 and 18 took part, all receiving care from Children and Adolescent Mental Health Services (CAMHS) or Early Intervention in Psychosis services (EIP) within Sussex and Hampshire. 

• Open access paper: Distress factors of voice-hearing in young people and social relating: Exploring a cognitive-interpersonal voice-hearing mode
• Part of the project results have been published in a scientific magazine. You can read it online for free here
• Here is a summary of the findings.

What this means

• It seems important to pay attention to young people who might rely a lot on their relationship with their voices. This could be a sign that they are having difficulties in their social lives.
• Young people who ask for support from mental health services and hear voices could also have negative beliefs about themselves and other people. They could also be going through a tough time with their emotions, such as feeling depressed or anxious. Although they may have had difficulties in the way they connect with others before hearing voices, the voices can make things even more challenging, and they might need help to cope with these experiences.
   

The AppRoVe study evaluated 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 who 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 below:

• Approve-Voices
• Approve-Social questionnaires

For more information: email mark.hayward@spft.nhs.uk.